Transsexuals In Iran Have Governmentally-Subsidized Transition Surgery

And in America, some Banana Republican-misled states’ officials want to deny are denying transsexual people basic human rights… even denying them fundamental equal rights – American Civil Rights – guaranteed to everyone (but denied to them) by the U.S. Constitution.

Go figure.

Again, in Iran – a far right-wing religiously-run conservative state government – transsexuals have sexual reassignment surgery at government expense. And, it’s A-OK with their nation’s imams (powerful religious leaders).

But in America, Banana Republicans (Banana Republics need Banana Republicans, rights?) are the embodiment of “Just say ‘NO!'” to everything – civil rights, voting rights, equality under law, etc.

They are literally “Governmental Deconstructionists” hell-bent upon destroying government, rather than strengthening it, and by extension, as part and parcel of that grand objective, are de-funding it through various and sundry tax cuts for the wealthy.

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Iran: How Transgender People Survive Ultraconservative Rule

– Deutsche Welle, DW – 16.05.2021
by Monir Ghaedi 

Iran’s state subsidizes gender reassignment surgery while prohibiting homosexuality. A long and continuing history of activism has helped transgender people bolster their community despite the discrimination they face.

Before getting gender-confirmation surgery, Saman Arastoo had pondered all of the consequences. At the age of 40, he had built an acting career in Iranian cinema and theater as a woman. He knew that his decision would hurt his career, but he had plans to replace it. Now he spends most of his time making sure that trans boys and girls do not rush into sex-change surgery — a rather easy option in Iran.

Saman Arastoo has achieved a certain measure of success as a theater director in Iran

Despite Iran’s rigid attitudes toward sexuality, its capital, Tehran, has been dubbed one of the world’s hubs for sex-reassignment surgery. Transgender individuals live and work with no legal barriers in the country. The government even helps with the costs of hormone medicine and gender reassignment surgery for those who want it.

The procedure became legal following a transgender woman’s campaign in the mid-1980s. Maryam Khatoon Molkara met Ruhollah Khomeini, then Iran’s religious and political leader, and told him how she had been put into a psychiatric institution and forcibly injected with male hormones. Moved by her story, Khomeini issued a decree, allowing the operation and endorsing civil rights for transgender people.

When it comes to other forms of non-heterosexual identity,

Research: 550,000+ Firearm-Related Hospitalizations 2000-2016

States in the Deep South lead the nation in average per capita firearm-related hospitalizations.

Average Firearm Injury Hospitalization Rate per 100,000, 2000–2016

1.) Louisiana – 24
2.) Tennessee – 18
3.) Alabama – 16
4.) Missouri – 16
5.) Maryland – 16
6.) Michigan – 14
7.) Illinois – 13
8.) North Carolina – 13
9.) South Carolina – 13
10.) Mississippi – 13
11.) Arizona – 13
12.) Arkansas – 12
13.) Delaware – 12
14.) Pennsylvania – 12
15.) Nevada – 12
16.) California – 12
17.) Oklahoma – 11
18.) Texas – 10
19.) Kansas – 10
20.) Indiana – 10
21.) Ohio – 10
22.) Kentucky – 9
23.) Virginia – 8

The national average is 10.

Ongoing and recently updated research by the RAND Corporation – a nonprofit, nonpartisan, research organization working in the public interest to develop solutions to public policy challenges to improve communities nationally, and worldwide by making them healthier, and more prosperous, safer, and more secure – showed that nationally:

“In 2018, 39,740 individuals in the United States were killed by firearms, making firearm violence the second leading cause of injury death in the United States (Centers for Disease Control and Prevention [CDC], undated).

“As part of the Gun Policy in America initiative, RAND researchers developed a longitudinal database of state-level estimates of inpatient hospitalizations for firearm injury between 2000 and 2016. This database was first released in 2021 and is free to the public.

RAND researcher Dr. Andrew Morral, PhD who is the Senior Behavioral Scientist, and Director of the National Collaborative on Gun Violence Research there, tweeted recently (April 28) that:

“Why are firearm hospitalizations not correlated with gun ownership in observed state hospitalization data or our estimates? Because they chiefly result from criminal assaults (vs. suicides) and these are not correlated with household gun ownership.”

Why are firearm hospitalizations not correlated with gun ownership in observed state hospitalization data or our estimates? Because they chiefly result from criminal assaults (vs suicides) and these are not correlated with household gun ownership https://t.co/pqVOh9t4bT

— Andrew Morral (@AndrewMorral) April 29, 2021

This type of research is a phenomenally difficult proposition, and highly complicated undertaking, and the entirety of the paper is spent detailing and explaining their methodology, and sources, because not every state provides information to, or participates in HCUP, the Healthcare Cost and Utilization Project.

As well, data had to be compared and cross-referenced with other similarly related databases, such as the FBI’s annual UCR – Uniform Crime Report.

And then, they get into the math – the statistical analysis – and explain the formulae used, which then has to be checked with other external mathematical models to determine, and ensure a high level of accuracy. In short, this is not “relaxing reading” by any stretch of the imagination – it is highly technical explanations of phenomenally difficult work, which only indirectly points to the significance of their findings.

HCUP is the Nation’s most comprehensive source of hospital care data, including information on in-patient stays, ambulatory surgery and services visits, and emergency department encounters. HCUP enables

Gun Ownership + Carrying + Impulsivity = Increased Firearm Violence Victimization & Death Risk

Think you need a gun “for protection”?

Think again.

The glibly superficial “good guy with a gun” notion is but a trite and specious fallacy.

Research has shown that “that individuals in possession of a gun are over four times more likely to be shot in an assault than those not in possession.”¹

Thus, while gun carrying itself is not a violent behavior, “it potentially marks heightened risk among gun carriers.”

And indeed, “research has demonstrated a strong link between (gun carrying) and gun violence victimization.”¹

“The finding has important implications for states and campuses considering open carry laws α while these policies may be intended to increase safety, they may have the unintended result of increasing gun violence victimization.”²

“On average, guns did not protect those who possessed them from being shot in an assault.³ Although successful defensive gun uses occur each year, the probability of success may be low for civilian gun users in urban areas. Such users should reconsider their possession of guns or, at least, understand that regular possession necessitates careful safety countermeasures.”

“Impulsivity was identified as

Houston, TX Hospital System To Fire Employees Who Refuse COVID-19 Vaccination

Houston Methodist Hospital, a not-for-profit 8-hospital system – 4 of which are ANCC Nursing Magnet status accredited – and academic medical center, with over 2502 beds in the Houston, Texas metro area, has publicly announced that they will fire any employee who refuses to get a COVID-19 vaccination.

The Houston Press and Houston Chronicle reported today, Thursday, 22 April 2021, that Bob Nevens, the hospital chain’s Director of Corporate Risk and Insurance, and Jennifer Bridges, a Houston Methodist Registered Nurse at the system’s Baytown facility, are on schedule to be fired soon if they don’t comply by obtaining a COVID-19 vaccine within the hospital system’s deadline of June 7, 2021.

Dr. Marc L. Boom, MD, the hospital system’s CEO, had the idea to require all employees to get vaccinated against COVID-19 in order to keep their jobs, and offered $500 incentive bonuses to any employee who demonstrated proof of vaccination. Houston Methodist was the first hospital system nationally to make COVID-19 vaccination mandatory for employees.

Houston Methodist Hospital

And to this point, a clear majority – 84% – of the hospital system’s 26,000 employees have received at least 1 COVID-19 vaccine dose as of Tuesday this week, according to Houston Methodist’s Director of Public Relations Stefanie Asin.

Houston Methodist’s Human Resources Department has stated that the hospital system will consider requests from employees who don’t want to be vaccinated for medical or for religious reasons.

However, neither Mr. Nevens nor Nurse Bridges are refusing COVID vaccination on those grounds. And neither Mr. Nevens, who is a 10-year hospital system employee, nor Nurse Bridges, who is a 7-year employee, consider themselves “anti-vaxxers,” and both have for many years received the annual influenza vaccine.

Mr. Nevens and Nurse Bridges have both said that their reluctance to receive COVID-19 vaccinations arises fromtheir concerns with the vaccines’ emergency approval by the U.S. Food and Drug Administration, rather than the more well-known and much lengthier standard, traditional, and much more well-known approval process.

Nurse Bridges said that as a Registered Nurse, “I’ve taken every vaccine you’re ever supposed to take. We just want more

The Alabama Attorney General’s Office Has IDIOTS Working There

This matter was just brought to my attention.

The figure 0.3% is 3/10ths of 1% (three tenths of one percent) – NOT “three one-thousandths” as they incorrectly wrote.

Any grade school child should be able to tell the difference.

Note the emboldened text highlighted in purple on the lower portion of the page.

And examine the dates…

NO ONE has caught that gross error since the time it was written – 2 years 4 months 20 days
or 28 months 20 days
or 124 weeks 3 days
or 871 calendar days

and updated –
1 year 7 months 26 days
or 19 months 26 days
or 86 weeks 2 days
or 604 calendar days.

If the folks working in that office are that dimwitted, or lazy – take your pick – what does that say about the rest of the state government?

Remember: Steve Marshall’s incompetency is precisely why former Governor Bentley wanted him in that office, in order to avoid prosecution.

The history of it all is utterly Machiavelian – Steve Marshall fired Matt Hart, a former Federal Prosecutor who was a tenaciously aggressive and fearsome Special Prosecutor for the State, who

Research Study Finds COVID-19 Numbers Vastly Underestimated

This is some of the first proven and confirmed evidence that what we have been told by the experts is 100% accurate and true.

“Typhoid Mary” Mallon (1869-1938), was an impoverished, illiterate Irish emigrant to the United States who worked primarily as a cook, and who became infamous for spreading typhoid fever, which at the time was an incurable, easily-spread, often deadly disease, for which no vaccination existed.

People who DO NOT KNOW THEY ARE INFECTED ARE SPREADING THE DISEASE BECAUSE THEY DO NOT HAVE SYMPTOMS.

It is a REPEAT of the classic example first shown by “Typhoid Mary” Mallon (1869-1938), an Irish emigrant to the United States who worked as a cook (one of the highest paying jobs at the time), and was actively infected with typhoid fever, yet NEVER – NOT EVEN ONCE – showed any signs of infection.

Tragically, however, as was common in the era in which she lived, she had low education and was practically illiterate, and her refusal to heed the advice of experts, and her insistence upon working in kitchens, resulted in the deaths of many people whom she thereby infected with typhoid fever because of her deliberately wanton disregard of advice, and disobedience to the order of law. She, however, claimed that she was being persecuted for being Irish and poor.

Her case was the first, and a prime example of the dangers of ignoring sound expert medical and scientific advice. As well, her case demonstrated the differences in attitudes toward public health between now, and then, because she filed lawsuits against the governmental authorities that detained her, and forbade her from either working, or being in public, and quarantined her. At the time, there was no vaccine against typhoid.

And throughout the remainder of her life, and up to the time she died, she never – not even once – ever showed signs of typhoid fever infection. And she did not die of typhoid fever. She died of

Death and Dying: By the Numbers In America

QUESTION: How many people in the U.S. die each day from overdoses involving PRESCRIPTION opioids?

ANSWER: According to recent data published by the Center for Disease Control (CDC), approximately 41 people/day (14,965) are dying from an overdose involving prescription opioids. This CDC website – https://www.cdc.gov/rxawareness/index.html – provides resources for individuals struggling with opioid drug abuse.

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330,147,087

That’s the estimated population in the United States as of this writing, according to the U.S. Census Bureau’s Population Clock.

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.

539,320

CORONAVIRUS may NEVER “Go Away”

Welcome to the “new” reality.

But, just for a moment, let’s play “What if?”

What if the United States’ failed response (because of the inactions and deliberate failures of the previous administration) was the primary cause of the mutated, more virulent variants?

It’s entirely plausible.

Otherwise, how to explain that the United States, with the world’s 3rd most populous nation – China and India each have WELL OVER 1 BILLION MORE – has ABSOLUTELY THE WORLD’S WORST COVID-19 INFECTION RATE?

Other nations, most notably New Zealand, have had phenomenal success in keeping the disease at bay, relatively speaking, as have a few other nations, including China, India, Greenland, Australia, other Scandinavian nations, and… well, you get the picture.

Perhaps there should’ve been a sign:

Choose One: Your Life, or Your Freedom.

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“When Will It End?” : How A Changing Virus Is Reshaping Scientists’ Views On COVID-19

https://www.reuters.com/article/us-health-coronavirus-variants-insight/when-will-it-end-how-a-changing-virus-is-reshaping-scientists-views-on-covid-19-idUSKBN2AV1T1

CHICAGO (Reuters) – Chris Murray, a University of Washington disease expert whose projections on COVID-19 infections and deaths are closely followed worldwide, is changing his assumptions about the course of the pandemic.

Murray had until recently been hopeful that

How To Quickly Vaccinate Everyone

This morning, bright and early around 0300 (that was the timestamp upon it, I was blissfully asleep then), I received an email from a friend and his better half whom are expats in Kitahiroshima on the island prefecture of Hokkaido, in northernmost Japan, near where her parents reside.

He wrote in part that “Vaccinations for coronavirus have started here but only for those with the highest priority (which makes sense).”

In that message, he also included a copy of an email communique from the United States Department of State which read in part, “The United States Government does not plan to provide COVID-19 vaccinations to private U.S. citizens overseas.”

In my reply, I wrote in part,

New International Guidelines For Cannabis In Treating Chronic Pain

New Guidelines Issued on Medical Cannabis for Chronic Pain

International task force shares recommendations for dosing, administering.

by Ryan Basen, Enterprise & Investigative Writer, MedPage
September 13, 2020

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Chronic pain patients can be treated with medical cannabis following one of three protocols based on patient characteristics, according to an international task force at the virtual PAINWeek meeting.

Note the words “NO OPIATES” PROMINENTLY displayed on the label.

Citing limited clinician knowledge about medical cannabis treatment and the opioid crisis, one task force member said the recommendations are timely.

“We as a task force believe it’s extremely important to bring [medical cannabis] to patients,” Alan Bell, MD, of the University of Toronto, told MedPage Today. “Our main focus was to provide directions to clinicians.”

Medical cannabis has been suggested to treat chronic pain, the task force noted, but too many providers still do not utilize it because there has not been accepted guidelines about dosing and administration. Others prescribe medical cannabis without knowing how patients can properly dose.

“There’s a huge knowledge gap and no way clinicians can fall back on a specified dosing regimen,” Bell said.

Led by Arun Bhaskar, MD, of Imperial College Healthcare NHS Trust Pain Management Centre in London, the 20-clinician Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain used a modified Delphi process. Among their recommendations:

• Treat the majority of patients along the “routine” scale. This means

Contradicting Tennessee Governor Bill Lee On Abortion

Bill Lee is the 50th Governor of the State of Tennessee, a Republican, and is serving his first term in office, having been elected in 2018.

Vice President Kamala Harris two days ago Tweeted:
“On the 48th Anniversary of Roe v. Wade, we recommit ourselves to ensuring that everyone has access to care—including reproductive health care—no matter their income, race, zip code, health insurance status, or immigration status.”

On the 48th Anniversary of Roe v. Wade, we recommit ourselves to ensuring that everyone has access to care—including reproductive health care—no matter their income, race, zip code, health insurance status, or immigration status. https://t.co/2CMdjihsXV

— Vice President Kamala Harris (@VP) January 22, 2021

Tennessee Governor Bill Lee included the Vice President’s Tweet with a response of his own:
“Abortion isn’t healthcare.”

Abortion isn’t healthcare. https://t.co/hpHnvw5pso

— Gov. Bill Lee (@GovBillLee) January 22, 2021

I’d like to address this entry to Governor Lee, and to every other person who, for whatever reason, opposes abortion – though opposition to the procedure is mostly religious-based, and that itself presents a Constitutional problem, insofar as our nation is not established upon any religion, and I mean specifically to refer to the “Establishment clause” of the First Amendment. I am NOT going to argue religion, that is for theologians, and I am not making a theological argument.

First, it is a very dangerous precedent to write a law that not only eliminates one’s ability to make an independent, and informed decision (about that, or any other private matter), but mandates that the government tell you (or anyone) what to do in your private life. That is the essence of what is happening with this type of argument. Proponents are: 1.) Forbidding exercise of Constitutional rights and freedom to make a free-will decision, and; 2.) Essentially forcing the pregnant woman to give birth to the child.

Regardless of whether one agrees, or not, that abortion should be discouraged, or even made illegal, the essence of what is happening is that, when government gets involved in a personal, private matter, there is no longer just a woman, and her physician, in that private treatment room, but 535 other people – 435 Representatives, and 100 Senators. And that’s just too many people in one small room.

Whenever government steps in and makes decisions for you, you no longer have freedom, you no longer have liberty. And whether they realize it, or acknowledge it, or not, that’s what the anti-abortion activists want – for government to make your decision, or more accurately, to deny you the ability to make a decision… one with which they disagree with upon religious grounds. Not only is that is the VERY antithesis of so-called “smaller, less intrusive” government (something about which GOP types have clamored about), but it is “Big Brother” government, another thing about which most right-wing, and GOP-type folks complain.

Second, contrary to the claims made by

Outgoing CDC Director Dr. Robert Redfield, MD is a FAILURE as a leader.

Dr. Robert R. Redfield, MD – 18th Director of the Centers for Disease Control and Prevention

But allow me to be more explicit.

Dr. Robert R. Redfield, MD is a goddamn moron for whom I have no professional respect.

Why do I write that?

Like his soon-to-be former boss – the outgoing 45th President – he is, and remains, an ineffectual (mis)leader, under whose oversight the agency, like America, has languished, and suffered significant loss. Furthermore, also like his soon-to-be former boss – the outgoing 45th President – he refuses to accept responsibility for any of it.

The outgoing President, himself an utterly incompetent goddamn know-it-all moron, has a knack and penchant for identifying and naming the most utterly incompetent boobs to important positions within the administration.

Does that mean Redfield is a “most utterly incompetent boob”?

Not necessarily.

Of course, if you’ve been paying the least bit of attention for the past year, or so, you’d know the moronic and utterly idiotic things he’s done, and the equally moronic and contradictory things he’s said to justify, in response to the coronavirus pandemic in the United States.

But here below, read what he said recently in an interview with NPR’s Mary Louise Kelly on All Things Considered. • [Commentary in italics, within brackets, preceded with a •, following Redfield’s remarks.]

Outgoing CDC Director Warns Of Pandemic’s Peak:
“We’re About To Be In The Worst Of It”

January 15, 20216:07 PM ET
Heard on All Things Considered
by Mary Louise Kelly

Mary Louise Kelly: “Why has the U.S. done so much worse than the rest of the world?”

Robert Redfield: “I think this virus has a unique ability to have differential pathogenesis in different people. And what it really does is it exploits the underlying health condition of the individual it infects. And so, I would argue one of the reasons we’re having more significant death in this country than, say, Sweden is because unfortunately, the underlying health conditions — with obesity, diabetes, heart disease, kidney disease and the significant health disparities that we have in these illnesses in our nation — haven’t been effectively addressed.”
• [Pass the buck, please. There is EXACTLY ONE research paper in the entire National Library of Medicine with the subject “differential pathogenesis” in its title which is about COVID-19: Molecular Aspects of COVID-19 Differential Pathogenesis. The gist of the paper’s findings is that a type of the female hormone estradiol increases the levels of Angiotensin-Converting Enzyme 2 (ACE2), and that ACE2 apparently has some role in preventing severity of symptoms associated with COVID-19 infection, although, “ACE2 expression is dramatically reduced with aging in both genders. The levels of ACE2 expression, which could be sex- and age-dependent, have a protective role against lung and kidney injuries that could impact the severity of COVID-19 illness in male vs. females and old vs. young individuals.” As well, TMPRSS2, a cellular transmembrane protease, has a role in the severity of the disease, insofar as the “expression levels of TMPRSS2 protein are regulated by levels of androgen and androgen receptors … women and children have a lower level of androgen and androgen receptors than men, and therefore, TMPRSS2 could play a potential role in the severity of COVID-19 pathogenesis in men.” The study’s authors also write that, “it could be possible that the expression levels of ACE2 and TMPRSS2 impact virus infectivity and pathogenesis among different groups of individuals, considering the variation in the expression levels in older men compared to the women and children.” It is well known that individuals with comorbidities of hypertension, diabetes mellitus, heart diseases, and cerebrovascular disease, are at increased risk for poor outcomes, and increased risk of mortality, if infected with COVID-19, and the authors specifically state that the treatments for such conditions may very well place such individuals at increased risk for poor outcomes by writing that they “could be linked to the ACE2 function during SARS-CoV-2 infection and the cardio-metabolic treatments that may interfere withACE2–virus interaction.” The study’s authors conclude that, “variations in the expression levels of SARS-CoV-2 receptors and co-receptors, due to physiological and co-morbidity conditions, could impact the differential pathogenesis of COVID-19.” Contrary to what Dr. Redfield says, the virus does NOT have “a unique ability to have differential pathogenesis in different people.”]

Kelly: “But in terms of how the U.S. has responded, in terms of how the CDC has responded … are you able to defend the Trump administration’s record on this as anything other than a catastrophic failure?”

Redfield: “Well, I’m actually very proud of the response that CDC has done. I think if I have one criticism that

“Just say ‘NO’” has never worked. Here’s what does.

Freedom.

What a concept, eh?

The very idea that you have a brain, and therefore, can think independently to decide FOR YOURSELF what you want, or ought, to do, continues to frustrate others who think that they know better than you do what personal decisions you should make for yourself!

It’s an adult decision.

Why, it’s nothing short of… LIBERTY!

ENOUGH! of the “Nanny State”!

Take your religion home, and GET IT OUT OF GOVERNMENT!!

Practice it PRIVATELY, with your family, friends, and other like-minded individuals. STOP forcing your PRIVATE religious ethics and morals upon others by writing public laws that mirror your private interpretation of your religion.

Thomas Jefferson wrote a letter to the Danbury Baptists that cited the establishment clause of our nation’s Constitution, which as he wrote, erected a “a wall of separation between Church & State,” or as we now say, between government, and religion.

Religious nuts have been trying to tear it down, ever since.

And they’re STILL TRYING TODAY!

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‘Drug Use For Grown-Ups’ Serves As An Argument For Personal Choice

If you grew up scared of what illicit drugs could do to you — hearing about all the horrors that could befall you from everyone from Nancy Reagan to your parents — the threat may have felt very real: If you actually took a puff off that joint that the kid who slept through math class offered you, it could lead to failed relationships, chronic unemployment, self-destruction.

The shame would outlive you.

But drugs are a more complicated matter than they’ve been made out to be, according to Dr. Carl L. Hart. In his new book Drug Use for Grown-Ups, the Columbia University professor of psychology and psychiatry zealously argues that drug use should be a matter of personal choice — and that, in more cases than not, personal choice can lead to positive outcomes. His positions may seem quite extreme to some but they also, by and large, make a lot of sense — and are backed up by ample research.

A major reason drugs have such a negative public image, Hart asserts, is racism. He notes that after the Civil War, some Chinese railroad construction workers smoked opium and, sometimes, established “opium dens” to do so. Over time, more and more white Americans visited these dens to smoke opium too. That in turn led to broader, bigoted social fear among whites, like, for example, the sentiments captured in H.H. Kane’s 1882 report:

“The practice spread widely…Many women and young girls, as also young men of respectable family, were being induced to visit the dens, where they were ruined morally and otherwise.”

Then there was the post-Civil War use of cocaine among some Black day laborers, something Hart writes was at first encouraged by white employers because of the productivity it could promote. Soon enough, however, articles appeared widely that tried to make a connection between African American cocaine use and criminality. One particularly egregious article in The New York Times in 1914, cited by Hart, even reported that some police in the South “who appreciate the vitality of the cocaine-crazed” were switching to higher-caliber weaponry capable of “greater shocking power for the express purpose of combating ‘the fiend’.”

But horrifying history aside, one of the book’s most eye-opening aspects is its challenge of the long-running association between drugs and addiction. First the basics: Addiction, according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM – 5), must be a source of distress for a drug user. It must also interfere with a person’s job, parenting or personal relationships. Other indications of addiction may be

What We Don’t Know About COVID-19 CAN Hurt Us… And Probably Will

If you think healthcare is expensive now, wait until ALL those with COVID-19 start getting sick as they age, after the Banana Republicans trash the “preexisting condition” healthcare provision in the PPACA, and insurance companies return to “cherry picking” and denials.

Won’t that be more fun than a barrelful of monkeys?!

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COVID-19’s Long-Term Harms: What We Don’t Know Yet Could Hurt Us

Infectious diseases have afflicted humans for hundreds of thousands of years, shaping communities and cultures. The ways pathogens affect human health have been studied extensively for decades. We have learned that any given microorganism can be protean, or capable of changing, in its manifestations — from patients who experience no symptoms at all, to those who become acutely ill yet recover fully, to those who suffer chronic infection and live with the ever-present threat of deteriorating health.

In stark contrast, we have coexisted only one year with severe acute respiratory syndrome coronavirus 2, the virus that causes coronavirus disease 2019 (COVID-19), and are still learning the diverse ways this novel virus affects human health. During the first week of December, the National Institutes of Health convened a two-day workshop involving public health officials, medical researchers, and patients dedicated to discussing the post-acute health consequences of COVID-19. One of the primary goals of the meeting — to provide a definition for the long-term sequelae, or health consequences and symptoms, following acute COVID-19 — proved elusive. Variably termed “chronic COVID,” “long haulers” and “long COVID” by physicians, patients and the media, whatever you call it, the protracted symptom complex following COVID-19, seemingly affecting all organ systems, has emerged as an unanticipated, devastating outcome of the pandemic.

The earliest data out of Europe and the United States painted a concerning picture: The majority of hospitalized patients remained symptomatic weeks or months after their acute illness, the most common symptoms being fatigue and shortness of breath in approximately half of patients studied. Even patients who were never hospitalized had persistent symptoms several weeks later. Over ensuing months, the full gamut of persistent symptoms emerged, ranging from chronic fatigue, sleep disturbance, cognitive impairment, fast heart rates and exercise intolerance. The exact incidence of these symptoms and their time-course

How does the COVID-19 vaccine work? Ask the women who developed it!

Drs Emmanuelle Charpentier-L & Jennifer Doudna-R 2020 Nobel laureates creators of CRISPR gene editing tool

The mRNA vaccine which has been developed first by Moderna, then by Pfizer-BioNTech (Moderna was first to develop a vaccine, first to deliver it to FDA for research, but second receiving approval), and others, is truly amazing and remarkable for many reasons, not the least of which is that it, and the fundamental underlying science behind it – gene editing/splicing – has been made possible in significant, if not whole part, by women.

This is quite possibly the first disease to ever be primarily resolved by the research of female scientists.

A team of 2 women

Should I wash my groceries?

The visible portion of crud which came off after washing in dish washing detergent (Dawn®), and a wee bit of common, unscented household bleach.

Bluntly, hells fucking YES!!

And pandemic goofiness aside, AT ALL TIMES one (meaning YOU, dear reader) should wash fresh produce with a bit of unscented dish washing soap/detergent, and a wee bit of unscented common, household bleach.

No one knows what kind of “cooties,” germs, pathogens, bacteria, and otherwise bad “bugs” – including bug poo – have settled upon fresh produce.

In this example, I washed a bunch of celery, 3 green bell peppers, a bunch of cilantro, several jalapeño peppers, and 2 heads of broccoli.

How did I wash them?

In a basin of cool water I dissolved some Dawn® brand unscented dishwashing detergent/soap, and about a quarter cup of common, unscented household bleach. Suds are NOT necessary.

Simply dissolve the additive ingredients by gently stirring the water. The basin should be at least half full of water.

Place the ingredients/vegetables to be washed

A COVID-19 vaccine was ready January 13, 2020 – long before the pandemic began.

Margaret Keenan, a 90-year old Irish-English grandmother, was the world’s first to receive a coronavirus vaccination.

While the world is crowing about Margaret Keenan, a 90-year old Irish-British grandmother of four, being the first in the world to receive a coronavirus vaccine yesterday, on Tuesday, December 8, 2020, around 0630 local time (GMT) – she received the version collaboratively developed by the American company Pfizer and German company BioNTech – the American biotechnology company Moderna, in Massachusetts, had long had a vaccine developed.

Moderna had already designed a COVID-19 vaccine – mRNA-1273 – by January 13.

It was only recently, on  November 16, that they reported a 94.5% efficacy rate.

Moderna developed their vaccine only two days after the genetic sequence had been publicized internationally by Chinese researcher Professor Dr. Yong-Zhen Zhangm Ph.D. His humanitarian act of scientific generosity resulted in him being temporarily forced out of his lab.

Professor Dr. Zhang believes science holds the key to predicting viral outbreaks with similar accuracy as with which we now anticipate typhoons and tornadoes. He said, “If we don’t learn lessons from this disease, humankind will suffer another.”

Moderna’s vaccine design only took one weekend to develop at their Massachusetts facilities.

In fact, Moderna had completed development of their COVID-19 vaccine mRNA-1273 before the Chinese government had acknowledged the disease was transmitted by human-to-human means, and more than a week before the first confirmed coronavirus case in the United States – January 21.

And by the time the first American coronavirus death was reported a month later, on February 29, Moderna’s mRNA-1273 coronavirus vaccine had already been manufactured and shipped to the National Institutes of Health to begin its Phase I clinical trial.

All of that was long before the President had made any announcement about his “Operation Warp Speed,” the public-private partnership to develop a coronavirus vaccine, and yet even 2 months before Bloomberg News reported on April 29 that such a plan was in the works.

Regarding the announcement of the first known coronavirus-related death, it should be noted that, following autopsy results in mid-to-late April, the Santa Clara County California Medical Examiner’s office reported on April 21 that the first known COVID-19 related death occurred in United States on February 6. The first death was previously thought to have occurred in Kirkland, Washington on February 29. The New York Times reported that, “The virus has an incubation period of 14 days and people who die of it are often sick for at least three weeks, so the individual who died on February 6 could have been infected — and transmitting the infection to others — in early January, experts said.”

In essence, what that means, is that for the entire time the COVID-19 coronavirus pandemic has infected well over 15 million – and counting – in the United States, we had the tools we needed to prevent it, as well as the death of over 250,000 Americans… and counting.

So, that begs the question: If Moderna had a vaccine ready in January, why has it taken until now – December, very nearly a year later – to have a vaccine readily available?

Moderna, a publicly-traded company (stock symbol: MRNA) with operations and headquarters in Massachusetts, is a biotechnology firm focused exclusively upon development of vaccines using mRNA – messenger RNA. Their vaccine is the first in the history of vaccine development to use mRNA.

Drs. Emmanuelle Charpentier-L & Jennifer A Doudna-R, are 2020 Nobel laureates, and creators of the CRISPR/Cas9 gene editing tool

Vaccines made using mRNA are fundamentally different from any other vaccine ever made. The history of vaccination began on May 14, 1796, when a country doctor from Gloucestershire, England, Dr. Edward Jenner, MD, first took some fluid from a cowpox blister and scratched it into the skin of James Phipps, an 8-year-old boy.

Dr. Jenner developed his vaccine while he was still a medical student, after noticing that milkmaids who had contracted a disease called cowpox, which caused blistering on a cow’s udders, did not catch smallpox. However, unlike smallpox, which caused severe skin eruptions and dangerous fevers in humans which often led to death, cowpox led to few ill symptoms in those women.

Science has come a very long way since then. While traditionally, vaccines were first made using active, live, then attenuated, then inactivated, or dead cells from the organism or virus. Throughout the history, the process of making vaccines used chickens’ eggs for the protein they contained, and were literally injected into the shell of an egg. Some are still made that way.

Most recently, two women have forever changed health, medicine, and many other life sciences, which gives hope to millions, and holds untold promises. Dr. Emmanuelle Charpentier, Ph.D., Director of Infection Biology at the Max Planck Institute, and Professor Dr. Jennifer A. Doudna, MD, Ph.D., Professor of Chemistry, Biochemistry & Molecular Biology, Li Ka Shing Chancellor’s Professor in Biomedical and Health at the University of California Berkeley, in October 2020 won the Nobel prize in chemistry for the development of the revolutionary CRISPR/Cas9 gene editing tool which has been described as enabling “rewriting the code of life.”

Drs. Emmanuelle Charpentier-L & Jennifer Doudna-R, are the 2020 Nobel laureates in chemistry, and creators of the CRISPR/Cas9 gene editing tool.

Cas9 is a type of modified protein and acts like a pair of scissors that can cut parts of DNA strands. CRISPR stands for Clustered Regularly Interspaced Short Palindromic Repeats, in essence, a repeating mirrored DNA sequence in genomes that repeats. The technology has worked in most every organism that it has been used on, including plants, animals, microbes and humans.

By using the gene editing platform CRISPR, which could be thought of as cut-and-paste, the idea is to remove parts of a genome using RNA as a means of guiding to a particular place within a genome, genes can then be modified to eliminate mutated, or harmful parts.

The ability to use such sophisticated gene splicing technology holds enormous promise.

As it relates to the coronavirus, the gene splicing technology uses a very small portion of messenger RNA (mRNA) from the coronavirus genome, and produces a gene that codes for the spike protein – the characteristic protruding part seen on images.

The coronavirus has 4 proteins, the spike is 1, and is the part that enables the virus to invade cells. By using only that part of the virus, it causes the body to produce antibodies that neutralize that spike protein. RNA vaccines cause the body to make only that spike protein. Then, encased in a fat molecule mRNA then enters cells, and sends a coded message to the body to make the protein, which in turn causes an immune response.

RNA vaccines have many advantages, which, unlike other vaccines produced other ways, they stimulate the production of killer T-cells which stop the coronavirus from replicating. And because mRNA vaccines are produced in test tubes or tanks, rather than being cultivated in cells (such as in eggs), they should be relatively quick and easy to produce.

The use of mRNA to treat disease, even genetic-based disease, such as cystic fibrosis, is brand new, but holds exciting possibilities. Moderna is perhaps one of the most promising mRNA therapeutics research firms in the world. And under the leadership and direction of Chief Science Officer Dr. Melissa Moore, Ph.D., Moderna has developed, and publicized, the scientific blueprint for a unique form of cancer therapy using mRNA which when used used, ensures its mRNA is made only inside cancer cells. Ryan Cross reported in Chemical and Engineering News on September 3, 2018 in “Can mRNA disrupt the drug industry? Messenger RNA technology promises to turn our bodies into medicine-making factories. But first Moderna—and a long list of old and new competitors—needs to overcome some major scientific challenges.” and wrote in part that, “Moderna scientist Ruchi Jain designed an mRNA that causes cancer cells to self-destruct but is recognized by, and destroyed in, healthy cells.”

Dr. Moore has a distinguished scientific pedigree, and

Cherokee Nation Winning War On COVID-19

Ah-yoh-gah (aka Little Foot) – Cherokee – 1875

The Cherokees are original residents of the American southeast region, particularly Georgia, North and South Carolina, Virginia, Kentucky, and Tennessee.

Nearly half of Oklahoma rests on land of five tribes whose members were forced west along the Trail of Tears in the 1800s — an expanse with nearly 2 million residents. Eastern Oklahoma’s other tribes are the Choctaw, Chickasaw, Seminole and Cherokee nations.

The Cherokee Nation is a sovereign tribal government. Upon settling in Indian Territory (present-day Oklahoma) after the Indian Removal Act, the Cherokee people established a new government in what is now the city of Tahlequah, Oklahoma. A constitution was adopted on September 6, 1839, 68 years prior to Oklahoma’s statehood.

Today, the Cherokee Nation is the largest tribe in the United States with more than 380,000 tribal citizens worldwide. More than 141,000 Cherokee Nation citizens reside within the tribe’s reservation boundaries in

Cherokee group preparing for a Stickball Game at Qualla Reservation in North Carolina – 1888

northeastern Oklahoma. Services provided include health and human services, education, employment, housing, economic and infrastructure development, environmental protection and more. With approximately 11,000 employees, Cherokee Nation and its subsidiaries are one of the largest employers in northeastern Oklahoma. The tribe had a more than $2.16 billion economic impact on the Oklahoma economy in fiscal year 2018.

The federally recognized tribes include the Cherokee Nation and the United Keetoowah Band, both in Oklahoma, and the Eastern Band of the Cherokee Nation in North Carolina. The Cherokee were one of the five “Civilized Tribes” of the east who were removed in the 1830s to land in the Indian Territory of Oklahoma.

The federally recognized Cherokee Nation has a 7,000 square mile jurisdictional area in fourteen counties of Northeastern Oklahoma. It is not a reservation. The Eastern Band of Cherokee, also recognized by the federal government, holds 56,000 acres within the Qualla Boundary of western North Carolina.

Headquartered in Tahlequah, Oklahoma, the Cherokee Nation has a tribal jurisdictional area spanning 14 counties in the northeastern corner of Oklahoma.

The Cherokee Nation is the federally recognized government of the Cherokee people and has inherent sovereign status recognized by treaty and law. The seat of tribal government is the W.W. Keeler Complex near Tahlequah, Oklahoma, the capital of the Cherokee Nation. With more than 300,000 citizens, 9,000 employees and a variety of tribal enterprises ranging from aerospace and defense contracts to entertainment venues, Cherokee Nation is one of the largest employers in northeastern Oklahoma and the largest tribal nation in the United States.

To learn more, please visit: https://www.cherokee.org.
For additional information, see also: The Treaty That Forced the Cherokee People from Their Homelands Goes on View, by Dennis Zotigh; April 24th, 2019, 11:00AM – https://www.smithsonianmag.com/blogs/national-museum-american-indian/2019/04/24/treaty-new-echota/

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“They’ve been following the science”: How the Covid-19 pandemic has been curtailed in Cherokee Nation

While the United States flounders in its response to the coronavirus, another nation — one within our own borders — is faring much better.

With a mask mandate in place since spring, free drive-through testing, hospitals well-stocked with PPE, and a small army of public health officers fully supported by their chief, the Cherokee Nation has been able to curtail its Covid-19 case and death rates even as those numbers surge in surrounding Oklahoma, where the White House coronavirus task force says spread is unyielding.

Elsewhere in the U.S., tribal areas have been hit hard by the virus. The Centers for Disease Control and Prevention reports that American Indian and Alaskan Native populations have case rates 3.5 times higher than that of white individuals. The Navajo Nation, where Covid testing, PPE, and sometimes even running water are in short supply, has seen nearly 13,000 cases and 602 deaths among its roughly 170,000 citizens. The Cherokee Nation, with about 140,000 citizens on its reservation in northeastern Oklahoma, has reported just over 4,000 cases and 33 deaths.

“It’s dire, but what in the world would it look like if we weren’t doing this work?’” said Lisa Pivec, senior director of public health for Cherokee Nation Health Services. Pivec leads a team that jumped into action in late February, holding coronavirus task force meetings twice a day, instituting procedures to screen thousands of employees, stockpiling PPE, protecting elders, ensuring food security, and educating residents in both English and Cherokee language. With no guidance on contact tracing available from the CDC early in the pandemic, Pivec researched the World Health Organization’s Ebola response to set up tracing protocols; after the first case appeared on the reservation March 24, she made many of the contact tracing calls herself.

She said the Cherokee Nation has seen no cases of workplace transmission; Sequoyah High School, with rapid testing and masks, reopened for in-person learning this fall; and elective medical and dental procedures have been widely restored.

The tribe’s Covid response meets the approval of global health leaders. “It’s very impressive. It’s a reminder of how much leadership matters and how even under difficult circumstances, with limited resources, you can make a huge difference,” said Ashish Jha, dean of the Brown University School of Public Health. “It fits with what I’ve seen in the world. You see countries like Vietnam. They’re not a wealthy country, but they’ve been following the science and doing a great job.”

If the U.S. had acted as the Cherokee Nation did, “we would be doing so much better,” Jha added, “with tens of thousands of fewer deaths, and probably a much more robust economy.”

The Cherokee Nation mounted an earlier and more aggressive response than neighboring states that have waited months — and are still waiting — for a national response. Pivec and other Cherokee leaders remain incredulous at the continued lack of federal leadership.

“It’s as if Russia had invaded the U.S. and the federal government said, ‘Every county should fend for itself,’” Pivec said.

A citizen of the Cherokee Nation, Pivec has stewarded the tribe’s public health program for nearly 30 years; in 2016, she helped the tribe become the first to be

The Secret Biden Voter

Last go ’round, we were surprised by “the secret Trump voters.”

No one predicted Trump’s victory – no one except for Professor Dr. Allan Lichtman, PhD.

He was the only one.

Of course, narcissist that he is, Trump thought it was just hyperbole, and thanked Dr. Lichtman – who himself is a Democrat.

This year, we’ll be surprised by “The Secret Biden Voters.”

But it won’t be a surprise.

In 1981, in conjunction with the now-late Vladimir Keilis-Borok (1921-2013), a Russian-born seismologist and geophysicist who worked on developing a reliable system of earthquake prediction, and taught at UCLA, Dr. Lichtman, who

Mississippi Voters To Decide On Medical Marijuana

If you have family and friends whom reside in Mississippi, the following will be of particular interest to you.

If not, it will still be of significant interest. We’ll explain why momentarily.

First, some background.

This year, Mississippians will have the opportunity to vote on whether, or not, they want to avail themselves, their loved ones, and friends, of the opportunity to use cannabis to treat the symptoms of their diseases.

The bill which would bring Medical Marijuana to Mississippi is called Initiative 65. The bill is fully written, and is not a mere hollow proposal. Establishing a complete infrastructure, Initiative 65 thoroughly lays out the plans by and through which cannabis would become available to medically qualifying Mississippians, including the regulatory agency and mechanism, the taxation structure, prescriptive authority, distributive network, farming and production facilities, product safety testing mandates, and more.

Mississippi, like some other states, has a public initiative process by and through which citizens have the ability to facilitate legislative action outside of their legislature. It is a direct type of democratic involvement, which for them is ensconced in their State Constitution. The Mississippi Secretary of State’s website writes explicitly that, “The Mississippi initiative law affords voters an avenue for addressing important constitutional issues which the State Legislature does not.”

The site further references the qualifying conditions that must be met in order for any prospective measure to be placed on the ballot – and win – by stating that,

“for an initiative measure to be placed on the ballot, a minimum of 106,190 certified signatures must be gathered with at least 21,238 certified signatures from each of the five congressional districts as they existed in the year 2000. Signatures must be certified by county circuit clerks. A completed petition is filed with the Secretary of State’s Office, along with a $500 filing fee. Not only must an initiative receive a majority of the total votes cast for that particular initiative, it must also receive more than 40% of the total votes cast in that election.”

Suffice it to say, the state law establishes a very high standard which prospective initiative measures must meet in order for them to be placed on the ballot, and then to pass. Whereas in most other states, a simple majority is often all that’s required for any candidate or measure to win, or to pass, in Mississippi, that state’s Initiative Law requires that IN ADDITION TO meeting all other qualifying conditions, it must be voted upon by AT LEAST 40.1% of all voters/ballots cast.

For purposes of illustration – if there are 100 TOTAL voters/ballots cast in an election, and only 30 out of the 100 voters voted on the measure (called an “undervote,” a condition in which all voters do not bother to vote on a particular race or measure), and voted for it to pass, and the nay votes were -0- (zero), despite the 30-0 victory margin, it will NOT pass, because it did NOT “receive more than 40% of the total votes cast in that election.”

Again, despite the fact that more voters voted FOR the measure to pass, than voted against it (which in this example would be zero -0-), or did NOT vote upon it, the measure still would not be considered to have passed.

Enter Mississippians for Compassionate Care.

Comprised of 76 diverse individuals from a variety of backgrounds including Physicians, Nurse Practitioners and Professors, Registered Nurses, Republican and Democratic politicians, Party Executive Committee members, State Legislators, and Local Officials from both major parties, Ministers, retired Military Service members, Business Owners and Executives, District Attorneys, retired Law Enforcement Officers, and more, they are the members of the steering committee which are guiding the measure called Initiative 65 which, if approved by voters, would establish a Medical Marijuana Law in Mississippi.

Initiative 65 is a well-though-out bill, one which is thoroughly considered, and the bill for the prospective measure contains practically every aspect of consideration which would be involved in establishing an entire infrastructure for Medical Marijuana.

The bill MS Initiative 65 Proposed Measure may be read/downloaded here.

Enter the Mississippi State Legislature.

Over the years, in over 20 attempts, the state’s legislators quashed every effort to help the people, and not once did they ever

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?

---

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

---

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, regularly 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 Monday, 03 May 2021

Effort is made to update this page regularly, and often, at least once weekly.

While the intended audience for these Q’s & A’s 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!

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QUESTION: Does the dosing of cannabinoid-based drugs need to be adjusted for patients with hepatic disease?

ANSWER: Cannabinoids are metabolized by the liver and excreted through the GI tract and kidney. When considering cannabinoid therapy for patients with severe liver impairment, the dosage may need to be adjusted. For example, according to the prescribing information for an FDA-approved cannabidiol product, “dose adjustment is recommended in patients with moderate (Child-Pugh B) hepatic impairment or severe (Child-Pugh C) hepatic impairment. It may be necessary to have slower dose titration in patients with moderate or severe hepatic impairment than in patients without hepatic impairment. [This drug] does not require dose adjustment in patients with mild (Child-Pugh A) hepatic impairment.”

Epidiolex prescribing information highlights:
https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/210365lbl.pdf

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QUESTION: Does the endocannabinoid system modulate pain without the being triggered by THC or other phytocannabinoids?

ANSWER: Yes. Neural and non-neural cells of injured tissues produce endocannabinoids, including anandamide and 2-AG, and when these endocannabinoids activate the CB receptors, pain signals are modulated. Note: CB1 receptors are abundant in nociceptive and non-nociceptive sensory neurons of the dorsal root ganglion (DRG), the spinal cord, the brain, mast cells, macrophage defense cells, the trigeminal ganglion (TG), and epidermal keratinocytes. Few CB2 receptors are expressed in these regions, but the density of CB2 receptors increases when peripheral nerve damage occurs.

reference: Breijyeh Z,Jubeh B, Bufo SA, Karaman R, Scrano L. Cannabis: A Toxin-Producing Plant with Potential Therapeutic Uses. Toxins (Basel). 2021 Feb 5;13(2):117. doi.10.3390/toxins13020117 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7915118/

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QUESTION: Other than via pills, capsules and liquid preparations, are there any other vehicles by which medical marijuana can be consumed orally?

ANSWER: In addition to pills, capsules and liquid preparations, medical marijuana can be consumed orally by ingesting marijuana-infused edibles, such as baked goods, candies, gummies, chocolates, lozenges, and beverages. It must be noted that the amounts of the various cannabinoids in edibles may not be consistent throughout a single baked product (a cookie, for example) or across a batch of baked products. As a result, it is difficult to estimate the amount of marijuana contained in each portion of edible product.

reference: Barrus DG, Capogrossi KL, Cates SC, et al. Tasty THC: Promises and Challenges of Cannabis Edibles. Methods Rep RTI press. 2016;2016:10.3768/rtipress.2016.op.0035.1611. http://europepmc.org/article/MED/28127591

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QUESTION: Do some cannabinoids reduce spasticity?

ANSWER: Studies have suggested that some cannabinoids effectively reduce the spasticity associated with multiple sclerosis, and, in fact, the federal drug agencies of several countries (but not the US) have approved a cannabinoid-based formula (50:50 THC:CBD) called Sativex (nabiximols) for the treatment of severe spasticity in multiple sclerosis. The cannabinoids act on the presynaptic CB1 receptors, and the receptor activation reduces massive glutamate release and regulates glutamatergic excitability during spasticity. The American Academy of Neurology proposes that the use of oral cannabinoid extracts or an oromucosal cannabinoid spray (1:1 THC:CBD) by MS patients may reduce symptoms of spasticity.

reference: Yadav V. Bever C. Jr et al. Summary of evidence –based guideline: complimentary and alternative medicine in multiple sclerosis: Report of the guideline development subcommittee of the American Academy of neurology. Neurology 2014. 82(12): 1083-1092. https://pubmed.ncbi.nlm.nih.gov/24663230/

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QUESTION: Is marijuana a sedative or stimulant?

ANSWER: Marijuana is a CNS depressant and may cause drowsiness or somnolence. Its CNS depressant effects are additive with other CNS depressants, including opioids. There is moderate evidence that marijuana or cannabinoids are effective for improving short-term sleep outcomes in individuals with sleep disturbance associated with obstructive sleep apnea syndrome, fibromyalgia, chronic pain, and multiple sclerosis.

reference: Kumar RN, Chambers WA, Pertwee RG. Pharmacological actions and therapeutic uses of cannabis and cannabinoids. Anaesthesia. 2001; 56: 1059-1068. https://pubmed.ncbi.nlm.nih.gov/11703238/

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QUESTION: What is the pharmacokinetic profile of marijuana when it is smoked?

ANSWER: When herbal marijuana is smoked via a cigarette or a pipe, THC, CBD and other phytocannabinoids, as well as terpenoids, 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. CNS effects appear within seconds to a few minutes of inhalation, reach a maximum after 15-30 minutes, and taper off within 2-3 hours. It must be noted that the amounts of cannabinoids consumed are, in part, dependent upon the patient’s inhalation techniques, including the quality and efficiency of inhalation, duration of inhalation, and spacing of inhalations.

reference: Huestis MA. Human cannabinoid pharmacokinetics. Chem Biodivers. 2007;4(8):1770-804. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2689518/. Grotenhermen F. Clinical pharmacokinetics of cannabinoids. J Cannabis Ther, 2003; 3(1): 3-51. https://www.tandfonline.com/doi/abs/10.1300/J175v03n01_02

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QUESTION: What is the pharmacokinetic profile of marijuana when it is smoked?

ANSWER: When herbal marijuana is smoked via a cigarette or a pipe, THC, CBD and other phytocannabinoids, as well as terpenoids, 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. CNS effects appear within seconds to a few minutes of inhalation, reach a maximum after 15-30 minutes, and taper off within 2-3 hours. It must be noted that the amounts of cannabinoids consumed are, in part, dependent upon the patient’s inhalation techniques, including the quality and efficiency of inhalation, duration of inhalation, and spacing of inhalations.

reference: Huestis MA. Human cannabinoid pharmacokinetics. Chem Biodivers. 2007;4(8):1770-804. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2689518/. Grotenhermen F. Clinical pharmacokinetics of cannabinoids. J Cannabis Ther, 2003; 3(1): 3-51. https://www.tandfonline.com/doi/abs/10.1300/J175v03n01_02

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QUESTION: What are endocannabinoids?

ANSWER: Endocannabinoids (also called endogenous cannabinoids) are endogenous agonists of the receptors to which delta-9- tetrahydrocannabinol (THC) also binds. Two of the most well studied endocannabinoids are derivatives of arachidonic acid: N-arachidonoylethanolamine (also called anandamide or AEA) and 2-arachidonoylglycerol (2-AG).

reference: Atakan, Z. “Cannabis, a complex plant: different compounds and different effects on individuals.” Therapeutic advances in psychopharmacology 2012; 2(6): 241-54. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3736954/

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QUESTION: What are terpenes?

ANSWER: Terpenes are aromatic hydrocarbons and just like the phytocannabinoids, terpenes are manufactured in the glands of the cannabis flower. Terpenes may influence the uptake and effects of phytocannabinoids. The terpenes found in cannabis include limonene, pinene, myrcene, delta-3-carene, eucalyptol and humulene.

reference: Russo EB. Taming THC:potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. Br J of Pharmacolo. 2011;163(7):1344-1364. doi:10.1111/j.1476-5381.2011.01238. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3165946/

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QUESTION: THC and CBD have significantly different receptor binding capacities, and thus different pharmacological effects. Are the differences in binding capacity due to different chemical compositions?

ANSWER: THC and CBD actually have the same chemical formula, C21H30O2. They are structural isomers. The key structural difference between the two molecules is that there is an oxygen-containing closed ring in THC that is open in CBD. This one structural difference leads to significantly different receptor binding capacities and thus different pharmacological effects of the two substances.

reference: de Meijer EP, Bagatta M, Carboni A, et al. The inheritance of chemical phenotype in Cannabis sativa L. Genetics. 2003;163(1):335-346. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1462421/

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QUESTION: True or False? CB1 receptors are only found on nerve cells.

ANSWER: False. In addition to the brain, nociceptive and non-nociceptive sensory neurons of the dorsal root ganglion (DRG), and the spinal cord, CB1 receptors are abundant in mast cells, macrophage defense cells, epidermal keratinocytes, adipose, liver, pancreas and skeletal muscle cells.

reference: Breijyeh Z, Jubeh B, Bufo SA, Karaman R, Scrano L. Cannabis: A Toxin-Producing Plant with Potential Therapeutic Uses. Toxins (Basel). 2021 Feb 5;13(2):117. doi.10.3390/toxins13020117 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7915118/

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QUESTION: What is the most common qualifying condition reported by medical marijuana patients?

ANSWER: Currently and historically, the most common qualifying condition reported by medical marijuana patients is chronic pain. In fact, according to Boehnke et al’s analysis of 2016 data, chronic pain was the qualifying condition reported by medical marijuana patients nearly 65 percent of the time.

ref. Boehnke et al. Qualifying Conditions of medical cannabis license holders in the United States. Health Affairs Vol 38, No2: Hospitals, Health IT and more. https://doi.org/10.1377/hlthaff.2018.05266. https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2018.05266

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QUESTION: Epidiolex is an FDA-approved seizure medication derived from plant material (it is not a synthetic CBD product). Is it possible that a patient taking Epidiolex will test positive for THC?

ANSWER: Epidiolex is cannabidiol (CBD) derived from marijuana, not hemp, and therefore there may be traces of cannabinoids other than CBD. Patients using Epidiolex may test positive for marijuana/THC on drug screening.

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QUESTION: Is it a good idea to store THC products in glass jars?

ANSWER: THC has the ability to bind to glass and plastic. Therefore, THC products are often stored in basic or organic solvents in amber silicate glassware to avoid loss.

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QUESTION: Do CBD products that contain less than 0.3 percent THC violate the Controlled Substances Act?

ANSWER: Industrial hemp (which contains less than 0.3 percent THC) is no longer considered to be a controlled substance, but CBD products that contain less than 0.3 percent THC are not legal. The CBD products no longer violate the Controlled Substances Act, but they do violate the Food, Drug, and Cosmetic (FD&C) Act, according to the FDA. Any CBD food or purported dietary supplement products in interstate commerce is in violation of the FD&C Act, according to the principal deputy FDA commissioner.

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QUESTION: What is industrial hemp?

ANSWER: Industrial hemp and marijuana are cultivated from the same species, but industrial hemp has concentrations of THC less than 0.3 percent. Industrial hemp, a high-fiber plant, is used to make various products, including textiles as well as biodegradable plastics. The 2018 Farm Bill, signed into law by President Donald Trump, removed industrial hemp, from the definition of marijuana in the Controlled Substances Act.

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QUESTION: Of all state-approved health conditions, what are the 7 most frequent health conditions for which patients seek to obtain a medical marijuana card?

ANSWER: Chronic noncancer pain, multiple sclerosis and other motor neuron disorders, epilepsy, cancer-related symptoms, mental health disorders (primarily anxiety disorders such as PTSD), glaucoma, and symptoms related to irritable bowel diseases top the list of reasons to apply for a medical marijuana card.

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QUESTION: CBD is legally sold in US supermarkets, pharmacies and convenience stores. CBD is also legally sold in Canada. So, is it legal to transport CBD across the US/Canadian border?

ANSWER: According to Canada’s national laws, “the transporting of cannabis (in any form, including oils containing THC or cannabidiol) into or out of Canada without special authorization from Health Canada is a serious criminal offense. “

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QUESTION: Does the dosing of CBD need to be adjusted in patients with liver disease?

ANSWER: According to the prescribing information packet of Epidiolex (an FDA-approved CBD product),, dose adjustment is recommended in patients with moderate (Child-Pugh B) or severe (Child-Pugh C) hepatic impairment. Dose adjustment in patients with mild (Child-Pugh A) hepatic impairment is not needed.

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QUESTION: Are physicians required to notify the DEA when prescribing Epidiolex (a CBD product derived from the cannabis plant)?

ANSWER: Prior to April 2020, Epidiolex was classified as a schedule V drug under the Controlled Substances Act. On April 6, 2020, the manufacturers of Epidiolex “received notification from the United States Drug Enforcement Administration (DEA) confirming that Epidiolex ® (cannabidiol) is no longer subject to the Controlled Substances Act (CSA).” Since Epidiolex is no longer a controlled substance, physicians are not required to notify the DEA when prescribing the medication. The descheduling of Epidiolex also enables physicians to prescribe this medicine free of the requirements of state prescription drug monitoring programs.

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QUESTION: Is the use of marijuana for medicinal reasons an acceptable explanation for a positive drug test result in ANY Federal agency drug testing program?

ANSWER: As of March 2021, the answer to this question is still ‘NO.’ ALL Federal drug testing programs – regardless whether the programs under the regulatory and legal auspices of the Department of Health and Human Services, the Department of Defense, the Department of Transportation, or the Nuclear Regulatory Commission, or any other Federal agency – have taken the identical stance: Use of Schedule I drugs by individuals in Federally regulated workplaces is unacceptable, and any individual who tests positive for a Schedule I drug will have a positive drug test on his or her record.

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QUESTION: If a patient uses a CBD product, will a THC drug screen be positive?

ANSWER: The answer to this question depends on 2 things: 1.) Is the patient consuming pure CBD or full spectrum CBD. (Full spectrum CBD contains multiple cannabinoids, including THC.) and 2.) The sensitivity of the drug screening test.

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QUESTION: How should cannabis products be stored?

ANSWER: Products should be stored in opaque containers, in a cool dry location, and in a place that is not accessible to children or pets, or individuals who should not be handling the cannabis-based products.

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QUESTION: What are some of the microbial and fungal contaminants that can be present in cannabis products?

ANSWER: Aspergillus and Salmonella and Aflatoxin may be present in cannabis products. It is important to review the certificate of analysis to determine if the cannabis product contains any of these contaminants.

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QUESTION: What should be listed on a Certificate of Analysis (CoA)?

ANSWER: First, a Certificate of Analysis (CoA) should be from an independent and properly certified testing laboratory, and not from the retailer. CoA should show the amount and concentration of major cannabinoids and terpenes present in the tested sample, as well as testing data regarding the lack of (or presence of) microbial organisms, fungal contaminants, the levels of heavy metals, and amount of pesticide and residual solvents.

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QUESTION: Does raw cannabis flower contain CBD or CBDA?

ANSWER: The raw flower contains CBDA (the acid form of cannabidiol). When the raw cannabis material is heated via vaporization, smoking or baking, the CBDA is converted to CBD.

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QUESTION: CBD products are marketed as full spectrum, broad spectrum and CBD isolate products. What are the differences between these products?

ANSWER: While full CBD spectrum products contain a full array of cannabinoids, (including THC) and terpenes, broad spectrum products are manufactured in a way that the product does not contain THC. CBD isolate products are often sold as 99%+ pure CBD and they do not contain other cannabinoids or any terpenes, unless specified on the label.

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QUESTION: How many people in the US die each day from overdoses involving PRESCRIPTION opioids?

ANSWER: According to recent data published by the Center for Disease Control (CDC), approximately 41 people/day are dying from an overdose involving prescription opioids. This CDC website – https://www.cdc.gov/rxawareness/index.html – provides resources for individuals struggling with opioid drug abuse.

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QUESTION: What is Rick Simpson oil (aka RSO)?

ANSWER: Solvent-based concentrates are made by extraction of the plant matter with chemical solvents. In this method, cannabis is soaked in the solvent and then the cannabis is removed by straining. Then, the solvent is boiled off, and a sticky cannabis resin remains. These extracts are often a very dark color (green to black) and contain residuals from the solvents used. These products are sometimes referred to as Rick Simpson Oil (RSO), named after the individual that made this type of extraction popular.

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QUESTION: Some people consume cannabinoids via “dabbing.” Describe this method of consumption.

ANSWER: Basically, with dabbing, a cannabis concentrate is applied to a hot platform and the cannabinoids are volatilized. The vapor then passes through a water-pipe device and is inhaled by the consumer. The hot platform (commonly called “the nail”) is usually constructed from quartz, ceramic or titanium. This nail is heated, often with a blow torch, and after the nail is hot, a small amount of cannabis concentrate is applied. Vaporization of the cannabinoids is immediate. Inhalation by the consumer during application of the cannabis concentrate draws the vapors from around the nail into the water pipe.

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QUESTION: Other than butane, what are some of the chemical solvents used to create cannabis concentrates? Other than using solvents to create cannabis concentrates, what other methods to produce cannabis concentrates can be used?

ANSWER: Hexane, isopentane, isopropyl alcohol, acetone, and propane are used to make cannabis concentrates. In addition to using solvents, concentrates can also be manufactured via a dry method, a water-based method or a CO2 based method.

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QUESTION: Do all medical marijuana legal states allow the sale of products manufactured through butane extraction and supercritical CO2 extraction?

ANSWER: Supercritical CO2 extraction does not leave residual hydrocarbons, while butane extraction does. As a result, some states will allow the sale of supercritical CO2 extraction products, but not allow the sale of butane extracts.

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QUESTION: In addition to butane extraction, supercritical CO2 extraction is another process used to manufacture cannabis extracts. What is the major difference in the end products of the two processes?

ANSWER: Supercritical CO2 extraction does not leave any trace of hydrocarbon solvents in the end product, while butane extraction does. The viscosity of the supercritical CO2 products is less than the viscosity of the butane extraction products. As a result of a lower viscosity, supercritical CO2 extraction process products can be used in vaporizer pens on its own without cutting agents. While products derived from a butane extraction are used in dabbing, products derived from supercritical CO2 extraction are not.

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QUESTION: Some patients may use shatter, budder, crumble, pull-and-snap, and/or wax. Are all of these products exactly the same?

ANSWER: All of these products are cannabis extracts, but it is the specific manufacturing/ processing of the hash oil cannabis products that will determine the consistency of the product. Depending upon the consistency and other physical characteristics, the product will be called shatter, budder, crumble, pull-and-snap or wax.

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QUESTION: Does short term treatment with THC rich cannabis induce clinical remission and improve quality of life in patients with mild to moderately active ulcerative colitis?

ANSWER: Yes, according to a recent study. However, these beneficial clinical effects were not associated with significant anti-inflammatory improvement in the Mayo endoscopic score or laboratory markers for inflammation. These results were derived from a double-blind, randomized, placebo-controlled trial, – 32 patients received either cigarettes containing 0.5 g of dried cannabis flowers with 80mg THC or placebo cigarettes for 8 weeks. Parameters of disease including Lichtiger disease activity index, C reactive protein (CRP), calprotectin, Mayo endoscopic score and quality of life (QOL) were assessed before, during and after treatment.

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QUESTION: In some legal states, edibles, such as candies, baked goods, beverages and condiments (butter and oils) containing THC may be sold. Is 2.5mg of THC in an edible a low dose or high dose of THC to be consumed orally?

ANSWER: The dosing of THC always needs to be adjusted on an individual basis. For reference, 2.5 mg is the lowest dose of dronabinol, a synthetic THC that is FDA-approved.

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QUESTION: When speaking with their clinicians, patients may use the terms “dabs”, “wax”, or “butane honey oil” – what do these terms mean?

ANSWER: Dabs, wax and butane honey oil are all highly concentrated cannabis extracts of THC. These THC products are often smoked or vaporized. Because these THC products are quite highly concentrated, the consumption of only a very small amount may produce a significant effect.

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QUESTION: What is “hashish”?

ANSWER: Hashish is a crude product made up of compacted sticky resin glands of the cannabis plant. The popularity of hashish has been diminished by the availability of cannabis concentrates.
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QUESTION: Are smoking marijuana and vaporizing marijuana equally efficient? (In other words, are the cannabinoids absorbed to the same extent with smoking vs. vaporizing? )
ANSWER: When ingesting marijuana via a vaporizer, the user absorbs up to 33% of the total cannabinoids present in herbal mixture. When smoking, an individual typically absorbs about 25% of the cannabinoids present in herbal mixture.
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QUESTION: The amounts of marijuana in a joint, blunt, spliff or bowl are not standardized. How does a clinician estimate the amount of marijuana being used by the patient?
ANSWER: When trying to assess the quantity of marijuana consumed by a patient, multiple questions should be addressed, including: how often and how much the patient typically purchases, how many bowls (or joints, or blunts or spliffs) the patient smokes each time he consumes marijuana, and how many times he uses marijuana before he needs to purchase again. It must be noted that the total amount of cannabinoids present in marijuana is not equal to the amount that is ingested. (when smoking, an individual typically absorbs about 25% of the cannabinoids present in herbal marijuana mixture.) Also, the concentration of the cannabis-based product must be considered, as well.

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QUESTION: Are smoking marijuana and vaporizing marijuana equally efficient? (In other words, are the cannabinoids absorbed to the same extent with smoking vs. vaporizing? )

ANSWER: When ingesting marijuana via a vaporizer, the user absorbs up to 33% of the total cannabinoids present in herbal mixture. When smoking, an individual typically absorbs about 25% of the cannabinoids present in herbal mixture.
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QUESTION: A patient may be speaking to you about his marijuana consumption, and he may use the terms joints, blunts and spliffs, and bowl. What do these terms mean?
ANSWER: A joint is a cigarette of marijuana, a blunt is a marijuana cigar, and a spliff can refer to marijuana mixed with tobacco, though some people use this term when referring to a cone-shaped joint with a filter. A bowl refers to the chamber of a pipe.

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QUESTION: In patients 60 years old or older, does long term (3 months) marijuana use impact blood pressure?

ANSWER: According to a recent study that was published in the European Journal of Internal Medicine, amongst adults 60 years or older with hypertension, marijuana treatment for 3 months was associated with a reduction in 24-hours systolic and diastolic blood pressure. At 3 months follow-up, the mean 24-hours systolic and diastolic blood pressures were reduced by 5.0 mmHg and 4.5 mmHg, respectively (p<0.001 for both). The nadir for the blood pressure and heart rate was achieved at 3 hours post-administration. The proportion of normal dippers changed from 27.3% before treatment to 45.5% afterward. No significant changes were seen in the different metabolic parameters assessed by blood tests, anthropometric measurements, or ECG exam.

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QUESTION: What are the effects of cannabis-based therapies on oxaliplatin-induced peripheral neuropathy among oncology patients?

ANSWER: The results of a retrospective study indicated that the rate of neuropathy was reduced among patients treated with cannabis-based therapies and oxaliplatin. This reduction was more significant in patients who received cannabis-based products prior to treatment with oxaliplatin, suggesting a protective effect. (A large prospective trial examining the effects of cannabis-based products on oxaliplatin-induced neuropathy is planned.)

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QUESTION: In older adults, is there a significant positive association between THC dose and incidence rate ratio for dizziness or lightheadedness and thinking or perception disorder when the THC is combined with CBD?

ANSWER: A systematic review and metaregression analysis published In JAMA (February 2021) evaluated the THC neuropsychiatric symptoms among adults 50 years and older. The authors examined 30 RCTs [Randomized Controlled Trials] using THC-only cannabis-based medicines (CBM) (total THC exposure, 1252.83 person-years) and 24 RCTs using CBMs with different combinations of cannabidiol (CBD) and THC (total THC and CBD exposure, 388.56 person-years). They did find a significant positive association between THC dose and incidence rate ratio for dizziness or lightheadedness (estimate, 0.05; 95% CI, 0.02-0.08; P = .001) and thinking or perception disorder (estimate, 0.07; 95% CI, 0.03-0.11; P < .001) for the THC-ONLY studies, but there were no associations with any other neuropsychiatric adverse effects for the THC and CBD combination studies.

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QUESTION: Can prison inmates use medical cannabis?

ANSWER: In New Mexico, the prison inmates can use cannabis. In 2021, a New Mexico landmark case concluded that inmates CAN use medical cannabis. As stated by the victorious lawyer, ‟the law is clear: You must, under existing law, provide incarcerated persons with the ability to access medical cannabis free from penalty. That’s the law.” Importantly, the ruling specifies that this applies to those on probation, house arrest or in prison.

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QUESTION: In 2020, the 20 member ‘Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain’ developed recommendations for the dosing of cannabinoids for patients suffering with severe pain. What were those recommendations?

ANSWER: According to the recommendations of the ‘Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain,’ patients suffering from severe pain and those patients who have a history of significant prior cannabis consumption can use a 50:50 CBD-THC product and start with a dose of 2.5-5 mg of each compound 1 or 2 times/day.

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QUESTION: In 2020, recommendations for the dosing of THC in the elderly population were developed by the 20 member ‘Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain.’ What were their recommendations for the dosing of THC in the elderly population?

ANSWER: According to the recommendations of the ‘Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain,’ elderly patients, patients with severe co-morbidity or patients who take multiple medications should be managed through a conservative route; start with THC doses at 1 mg/day and the dose should be titrated up slowly.

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QUESTION: What are some of the more common reasons dermatologists recommend cannabinoid-based medicines?

ANSWER: According to the results of a survey of 145 dermatologists, 91 % of dermatologists were in support of medical cannabis use and 13.8 % have recommended it for a dermatologic condition. Atopic dermatitis (45 %) and psoriasis (40 %) were the most common. The most common form of administration was topical (75 %). The main reasons for not recommending medical cannabis were limited knowledge (56 %) and lack of experience (48 %).

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QUESTION: In 2020, the 20 member ‘Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain’ developed recommendations for the dosing of cannabinoids. For what pain conditions are medical cannabinoids a viable option?

ANSWER: According to the global task force, cannabinoids may be effective for neuropathic, inflammatory, nociplastic* and mixed pain conditions. *Nociplastic pain is defined as: “Pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain.”

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QUESTION: Have any PRECLINICAL studies shown that cannabinoids have anti-neoplastic (anti-cancer) effects?

ANSWER: Yes – PRECLINICAL studies have shown that cannabinoids exhibit anti -tumor properties in different ADULT cancers, including breast, melanoma, pancreatic, lymphoma, glioblastoma, lung, hepatocellular, colorectal, prostate, and other cancers. This data has been obtained from EXPERIMENTAL models of cancer, including genetically engineered mouse models.

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QUESTION: The use of cannabinoid-based products for medicinal purposes is legal in Canada at the federal level. Is the medicinal use of cannabinoid-based products legal at the federal level in Mexico, too?

ANSWER: Yes, as of January 13, 2021, the use of cannabinoid-based products for medicinal purposes is legal in Mexico. Mexican President López Obrador published regulations for the production, research and use of medicinal marijuana. The federal government’s official gazette published the new regulations that authorize the government to oversee the production of marijuana for research and medicinal purposes. Pharmacies will be allowed to supply cannabis-based medicines to authorized patients. In addition, the regulatory framework permits the importation of seeds, cannabis derivatives to be used in medicinal products, and processed marijuana-based medications to Mexico.

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QUESTION: Does the National Basketball Association (NBA) test their players for cannabis use?

ANSWER: Prior to the 2020-2021 season, the NBA had randomly conducted cannabis testing on players, but the NBA and National Basketball Players Association announced they will stop testing players for cannabis use during the 2020–2021 season in response to the stress and quarantining brought on by the COVID-19 global pandemic, and also based on COVID safety to limit unnecessary contacts,. Although cannabis testing is paused for now, random testing for performance-enhancing drugs will continue.

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QUESTION: As of 2018, what percentage of the population uses marijuana?

ANSWER: The 2018 World Health Organization (WHO) data suggest that approximately 2.5% of the global population (147 million) use marijuana.

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QUESTION: Researchers have evaluated the anti-neoplastic (anti-cancer) effects of cannabinoids. What have the results indicated?

ANSWER: Over the past two decades, PRECLINICAL data indicate that THC, CBD, as well as some synthetic cannabinoids induce apoptosis of cancer cells and inhibit tumor proliferation, metastasis, and angiogenesis. Note: The results of preclinical trials are NOT equivalent to clinical trials.

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QUESTION: What are the two most well-studied endocannabinoids?

ANSWER: The best-characterized endocannabinoids are 2-arachidonoylglycerol (also called 2-AG) and N- arachidonoylethanolamide (also called AEA or anandamide). These endocannabinoids are lipid-based molecules that are synthesized from arachidonic acid from the cellular membrane. These two endocannabinoids are signaling molecules that bind to and stimulate cannabinoid receptors CB1R and CB2R.

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QUESTION: Which US states had the greatest sales of cannabis products in 2020?

ANSWER: Florida, a medical marijuana only state, had more than $1.2 billion in sales, and was the nation’s fourth largest cannabis market. Only California, Colorado and Washington (all medical and recreational use states) out sold Florida.

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QUESTION: CB1 receptors are expressed by neurons in the brain, especially in the cerebral cortex, basal ganglia, cerebellum, and hippocampus. Are CB1 receptors expressed in other parts of the nervous system? Are CB1 receptors present on cells outside of the nervous system?

ANSWER: In addition to being expressed by neurons in the brain, CB1 receptors are also expressed in parts of the peripheral and autonomic nervous system. CB1 receptors are also expressed on several other tissues, including heart, lung, reproductive organs, thymus and spleen.

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QUESTION: Does the consumption of THC and CBD via vaporization impair driving ability?

ANSWER: A recent study published in JAMA examined the magnitude and duration of driving impairment following vaporization of cannabis containing various concentrations of THC and CBD. The results of the study indicated that the impairment of driving after consuming vaporized THC-dominant and 50:50 THC/CBD cannabis compared with placebo was significantly greater at 40-100 minutes but not at 240-300 minutes after vaporization. There were no significant differences between CBD-dominant cannabis and placebo found, but the doses tested may not represent common usage.

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QUESTION: To which receptor do cannabinoids bind that impact pain sensation?

ANSWER: In addition to acting on cannabinoid receptors (CB1 and CB2), cannabinoids may modulate pain by interacting with the G protein-coupled receptor 55 (GPR55) and GPR18 and other G protein-coupled receptors such as serotonin and opioids receptors. Cannabinoids also interact with TRPV-1 receptors. CBD and THC (along with the endocannabinoid, Anadamide) activate glycine receptors, and as a result, lead to analgesia in inflammatory and neuropathic pain.

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QUESTION: Does the anti-fungal agent ketoconazole interact with cannabinoids?

ANSWER: Yes. Ketoconazole Inhibits the metabolism of THC and CBD and can significantly increase concentrations of THC and CBD. In contrast, drugs such as rifampicin, carbamazepine and St John’s Wort induce cytochrome enzyme activity and lower THC and CBD concentrations.

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QUESTION: If a patient is allergic to tomatoes or tobacco, is the patient a good candidate for medical marijuana therapy?

ANSWER: Patients who have previously experienced an allergic reaction to tobacco or tomato are at increased risk for developing an allergy to the products from the cannabis plant.

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QUESTION: Is a “full spectrum” product the same as a “whole plant” product?

ANSWER: No. “Whole plant” products contain fats, waxes and fibrous materials not found in “full spectrum” products.

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QUESTION: What does “full spectrum” marijuana mean? What does “broad spectrum” 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). In contrast, 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: 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: Have the results of studies examining the impact of maternal marijuana use identified a unique phenotypic congenital anomaly?

ANSWER: Studies evaluating maternal use of marijuana have not found a unique phenotypic signature of prenatal exposure of marijuana. There does appear to be an increased risk of congenital anomalies, particularly gastroschisis, though.

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QUESTION: In 2018, Epidiolex was 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 since 2018?

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: Does the use of cannabinoid-based products impact female sexual function, including desire, arousal, lubrication, orgasm, satisfaction, and pain?

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. (i.e. – sexual desire increased, arousal increased, orgasm domain increased, and sexual satisfaction increased.) Interestingly, it was noted that chemovar type and method of consumption did not impact outcomes, though.

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QUESTION: Does consuming a high fat/high calorie meal at the same time as you take liquid CBD orally impact the amount of CBD absorbed into the bloodstream?

ANSWER: Yes. According to studies performed by a pharmaceutical company that manufactures an FDA- approved CBD product, a high fat/high calorie meal can increase CBD absorption by up to 5 fold.

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QUESTION: Did the United Nations Commission for Narcotic Drugs vote in December 2020 to accept the World Health Organization’s (WHO) recommendation to remove cannabis and cannabis resin for medicinal purposes from Schedule IV of the 1961 Single Convention on Narcotic Drugs?

ANSWER: Yes, and it was a close one (27 to 25), with the United States and many European nations in favor. The US published a statement about its rationale for the vote – “The vote of the United States to remove cannabis and cannabis resin from Schedule IV of the Single Convention while retaining them in Schedule I is consistent with the science demonstrating that while a safe and effective cannabis-derived therapeutic has been developed, cannabis itself continues to pose significant risks to public health and should continue to be controlled under the international drug control conventions. Further, this action has the potential to stimulate global research into the therapeutic potential and public health effects of cannabis, and to attract additional investigators to the field, including those who may have been deterred by the Schedule IV status of cannabis.”

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QUESTION: The House of Representatives approved the MORE Act. Is marijuana legal now?

ANSWER: The House of Representatives approved the bill called the MORE Act on December 4, 2020, but marijuana is not legal at the federal level. The bill must go to the Senate, and then the White House for the President to sign. Until the President signs it, it’s not a law – it’s just a bill.

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QUESTION: What is the MORE act?

ANSWER: The Marijuana Opportunity, Reinvestment, and Expungement (MORE) Act (HR 3884 / S. 2227) is bipartisan legislation that removes marijuana from the Controlled Substances Act, thus decriminalizing the substance at the federal level and enabling states to set their own policies.

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QUESTION: Do cannabinoids affect cardiac function?

ANSWER: Low doses of cannabinoids have been associated with tachycardia, hypertension and increased contractility (an increased sympathetic response). In contrast, high doses of cannabinoids enhance parasympathetic tone leading to dose-dependent bradycardia and hypotension.

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QUESTION: What percentage of US medical marijuana legal states list cancer as a qualifying condition?

ANSWER: Cancer is listed as a qualifying condition in 100% of the US medical marijuana states, but the patterns of cannabinoid use among patients with breast cancer (one of the most common cancers in the US) is unknown. NOTE: Cannabinoids have been shown to ameliorate some of the symptoms associated with cancer and the side effects associated with some cancer treatments, however, cannabinoids have not been shown to be an effective anti-cancer agent.

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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 randomized controlled trials (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 nausea and vomiting is 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 dose administered; 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: 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 dose administered; 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: What is Sativex®?

ANSWER: Sativex® is a buccal (oral) spray containing Δ-9-THC and CBD (2.7 mg Δ-9-THC and 2.5 mg CBD per spray) and it is indicated for spasticity and neuropathic pain in multiple sclerosis, and as adjunctive analgesia for moderate to severe cancer pain. While Sativex® is approved in several European countries, Canada, and other countries, it has not been approved for medical use in the U.S.

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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 acute pain setting?

ANSWER: No. According to the results of multiple randomized controlled trials 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: What CBD products, if any, have been evaluated and approved by the FDA?

ANSWER: CBD is marketed in various forms, including oils, capsules, food products, cosmetics/topical lotions and creams, and CBD products are marketed for pets, too. These products are sold in grocery stores, specialty stores, and convenience stores across the US and on the internet. However, only one prescription CBD product has been approved by the FDA. It is called Epidiolex. It is approved to treat rare, severe pediatric epilepsy disorders.

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QUESTION: On the current (last revised May 2020) US Department of Justice Firearms Transaction Record form, is there a question related to the unlawful use of, or addiction to marijuana, depressants, stimulants, narcotics and other controlled substances?

ANSWER: Yes. There is a question related to drug use. In fact, there is a warning note that reads as follows: “Warning: The use or possession of marijuana remains unlawful under Federal law regardless of whether it has been legalized or decriminalized for medicinal or recreational purposes in the state where you reside.”

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QUESTION: Does consuming a high fat/high calorie meal at the same time as you take liquid CBD orally impact the amount of CBD absorbed into the bloodstream?

ANSWER: Yes. According to studies performed by a pharmaceutical company that manufactures the FDA-approved CBD product called Epidiolex, a high fat/high calorie meal can increase CBD absorption by up to 5 fold.

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QUESTION: What psychiatric condition is most often listed as a qualifying condition for medical marijuana?

ANSWER: The psychiatric diagnosis most often listed as a qualifying condition by the medical marijuana legal US states is PTSD, but other psychiatric diagnoses include Tourette syndrome, Alzheimer’s disease, and autism.

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QUESTION: Is marijuana use linked to higher hospital mortality in COPD patients?

ANSWER: Actually, no. According to a nationwide population-based study, patients diagnosed with COPD who reported using marijuana had less risk of in-hospital mortality and pneumonia than non-users. The results from this study, which was performed by Yale physicians, indicated that marijuana use was associated with a 37.6% reduction in the odds of dying in the hospital (OR 0.624, 95% CI 0.407-0.958, P=0.0309) among COPD patients. This same study also found that COPD patients who admitted to using marijuana had an 11.8% lower risk of pneumonia (OR 0.882, 95% CI 0.806-0.964, P=0.0059). Note: these findings may be a correlation rather than a causation, according to some clinicians not associated with the study. Also, the authors performed a retrospective analysis of COPD-associated hospitalizations over the years 2005-2014. (Pre-COVID)

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QUESTION: Is there a governmental office to which patients can report any adverse effects from CBD products?

ANSWER: Yes, even though CBD (with the exception of Epidiolex) is not approved by the FDA, patients can report any adverse effects from CBD products to the FDA’s MedWatch program.

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QUESTION: To date, has the FDA approved cannabis for the treatment of any psychiatric condition?

ANSWER: No. However, the FDA has approved 1 cannabis-derived medication (CBD) called Epidiolex and 2 cannabis-related medications (dronabinol and nabilone) for specific indications. Dronabinol is a synthetic THC product that is used as an antiemetic agent. It is approved for treating or preventing nausea and vomiting caused by chemotherapeutic agents, and as an appetite stimulant for individuals with AIDS. Nabilone is a synthetic that is structurally similar to THC. It is approved for treating chemotherapy induced nausea and vomiting.

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QUESTION: What percentage of Americans support marijuana legalization?

ANSWER: In a 2019 Pew Research Center survey, 67% of Americans supported marijuana legalization. Since that 2019 survey, more US states have legalized recreational marijuana.

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QUESTION: Does ketamine interact with cannabinoids?

ANSWER: Yes. Ketamine is a CYP3A4 substrate, and thus may inhibit the metabolism of cannabinoids, including THC. This, in turn, can increase blood levels of cannabinoids and possibly lead to fatal dysrhythmias, heart attack, or stroke, according to the American Heart Association. Also, ketamine levels may increase which can lead to negative effects, including agitated delirium, respiratory depression (ketamine is primarily an NMDA antagonist, but it may also bind to mu and the sigma receptors.)

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QUESTION: What is the most common reason for cannabinoid use among cancer survivors?

ANSWER: The most common reason for cannabinoid use among cancer survivors was pain. Other common reasons why cancer survivors used cannabinoids include sleeping problems and anxiety.

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QUESTION: What are the most common reasons older adults use cannabis-based products?

ANSWER: According to an anonymous survey of 568 adults age 65 or older, the majority (78%) used cannabinoids for medical purposes only, with the most common targeted conditions/symptoms being pain/arthritis (73%), sleep disturbance (29%), anxiety (24%), and depression (17%). Of note, only 41% reported that their healthcare provider knew that they use cannabinoids for medicinal purposes.

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QUESTION: Are symptoms of OCD significantly reduced after smoking or vaporizing marijuana?

ANSWER: Data from an app that tracks the changes of medical marijuana patients’ symptoms as a function of different doses and strains of cannabis across time was analyzed. The results indicate that inhaled cannabinoids appear to have short-term beneficial effects on symptoms of OCD. However, tolerance to the effects on intrusions may develop over time.

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QUESTION: Which US states have legalized adult-use marijuana possession and have also legalized adult-use marijuana sales?

ANSWER: As of October 10, 2020, the following 11 US states had legalized adult use marijuana possession and adult use marijuana sales: Alaska, California, Colorado, Illinois, Maine, Massachusetts, Michigan, Nevada, Oregon, Vermont, and Washington. Washington DC and Guam have also legalized adult use marijuana sales. In November 2020, Arizona, Montana, New Jersey and South Dakota legalized recreational marijuana, too.

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QUESTION: Are there any US states that do NOT deny solid organ transplants for patients that use marijuana for medicinal purposes?

ANSWER: Legislation has passed in at least 7 US states (California, Washington, Illinois, Arizona, Delaware, New Hampshire, and Maine) that explicitly forbids denial of transplantation listing on the basis of an individual’s use of medical marijuana. *Of note, transplant recipients take immunosuppressive drugs, and inhaled smoked or vaporized marijuana can expose the consumer to life-threatening pulmonary infections (Aspergillosis, for example). Typically, most US state solid organ transplant programs have recommended that individuals with active drug or alcohol abuse not undergo transplantation.

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QUESTION: Does THC stimulate the sympathetic or parasympathetic system?

ANSWER: Tetrahydrocannabinol stimulates the sympathetic nervous system while inhibiting the parasympathetic nervous system. After THC consumption, there may be increases heart rate, myocardial oxygen demand, supine blood pressure, and platelet activation. (Of note, THC is associated with endothelial dysfunction and oxidative stress.)

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QUESTION: What is the half life of CBD? How does it compare to the half life of THC?

ANSWER: The half life of CBD is 18-32 hours, which is similar to the half life of THC of 20-30 hours. Both CBD and THC are distributed to fatty tissues and highly perfused organs such as brain, heart, lung, and liver.

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QUESTION: At what point during gestation are endocannabinoid receptors expressed in the fetus?

ANSWER: Endocannabinoid receptors are first expressed in the fetus at 5 to 6 weeks’ gestation.

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QUESTION: Did past-month cannabis use among pregnant US women increase or decrease during the 15 year span of 2002 to 2017?

ANSWER: Past-month cannabis use among pregnant US women more than doubled from 2002 (3.4%) to 2017 (7.0%).

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QUESTION: Is prenatal exposure to cannabis associated with child outcomes?

ANSWER: The results of a cross-sectional analysis published in a September 2020 JAMA Psychiatry journal, indicate that prenatal exposure does impact child outcome. This particular cross-sectional analysis involved 11,489 children (655 exposed to cannabis prenatally) and the findings indicate that prenatal cannabis exposure after maternal knowledge of pregnancy was associated with greater psychopathology (i.e., internalizing, externalizing, attention, thought, and social problems, as well as psychotic-like experiences) during middle childhood, even after accounting for potentially confounding variables.

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QUESTION: Does marijuana use during pregnancy affect the birth weight of the baby?

ANSWER: Yes. According to a 2018 study by Campbell et al., marijuana use during pregnancy triples the likelihood of having a low birth weight baby, even after adjusting for factors such as socioeconomic status, medical history, and other substance use such as tobacco smoking

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QUESTION: What percentage of 12th graders in the US have used marijuana at least once in their life?

ANSWER: According to the National Institute on Drug Abuse’s Monitoring the future, nearly one half of all 12th-graders in the United States have used marijuana in their lifetime, with more than one third during the past year, and almost one quarter in the past month.

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QUESTION: What percentage of individuals who misuse prescription opioids seek treatment?

ANSWER: Only 8% of individuals who misuse prescription opioids seek treatment. Of note, approximately 80% of heroin users first misused prescription opioids.

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QUESTION: How does CBD impact the cardiovascular system?

ANSWER: CBD reduces heart rate and blood pressure, and improves vasodilation in models of endothelial dysfunction. Also, CBD reduces inflammation and vascular hyperpermeability in diabetic models.

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QUESTION: Compared to previous years, has the number of opioid deaths since the COVID pandemic increased or decreased?

ANSWER: Since the beginning of the COVID-19 pandemic, a dramatic increase in the number of opioid overdose deaths has been reported. According to a recent report put out by the American Medical Association, opioid overdose deaths have increased in more than 35 states since the pandemic began. This surge is believed to be multifactorial, and due to isolation, economic issues, disruptions to the drug trade and other factors.

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QUESTION: How many adolescents in the US misused opioids in 2018?

ANSWER: In 2018, 699,000 adolescents between the ages of 12 and 17 misused opioids, with the vast majority misusing prescription opioids. Of these 699,000 adolescents, 108,000 had opioid use disorder.

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QUESTION: Does substance use disorder increase the risk for COVID-19?

ANSWER: Yes, according to an analysis of electronic health records (EHR). As reported by Nora D. Volkow, MD, director of the National Institute on Drug Abuse, and colleagues, the evaluation of over 73 million electronic health records, the risk of COVID-19 was far greater among patients diagnosed with a substance use disorder in the past year compared with the general population after adjusting for age, gender, race, and insurance type.

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QUESTION: Does the oral administration of CBD alter plasma concentrations of diazepam?

ANSWER: CBD can alter the toxicity or efficacy of other drugs through inhibition of certain enzymes. For example, increases in the plasma concentration of diazepam have been reported when the diazepam is coadministered with Epidiolex (a CBD product).

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QUESTION: Has the use of a transdermal gel for regional and systemic delivery of CBD been evaluated for the treatment of epilepsy?

ANSWER: Yes. A transdermal gel for regional and systemic delivery of CBD (Zynerba Pharmaceuticals) is in clinical development for treatment of epilepsy, developmental and epileptic encephalopathy, fragile-X syndrome, and osteoarthritis. NOTE: As of September 2020, the company’s website indicates that the product is not yet approved by government regulatory bodies, including the United States Food and Drug Administration (FDA) and other agencies, and must be tested to see if it is an effective and safe treatment.

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QUESTION: Is cannabidiol in compounded topical pain creams safe to use?

ANSWER: According to the National Academies of Science, Engineering and Medicine’s 2020 publication A Review of the Safety and Effectiveness of Select Ingredients in Compounded Topical Pain Creams, “there is insufficient evidence on the safety of topical application of cannabidiol. However, if systemic absorption to therapeutic levels is achieved through topical application, there is potential for side effects similar to other routes of administration (e.g., oral).”

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QUESTION: Does cannabidiol in compounded topical pain creams penetrate the skin of animals?

ANSWER: According to the National Academies of Science, Engineering and Medicine’s 2020 publication, A Review of the Safety and Effectiveness of Select Ingredients in Compounded Topical Pain Creams, “there is limited preclinical evidence to suggest that cannabidiol penetrates animal skin. Modifications to the ingredient or excipient may increase aqueous solubility and increase absorption.”

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QUESTION: In PRECLINICAL studies, it has been shown that cannabinoids induce apoptosis of cancer cells. Do cannabinoids induce apoptosis of normal non-malignant cells?

ANSWER: According to the results of PRECLINICAL studies, including in vitro studies and and studies in mice, cannabinoids induce apoptosis of cancer cells without causing negative effect on the viability of normal non-malignant cells. In some mouse models, it has been noted that cannabinoids act synergistically with standard anti-cancer drugs or radiation therapy to reduce tumor growth. These studies have not detected overt signs of toxicity in the treated animals. NOTE: The observations noted in culture or animal models do NOT always readily translate into clinical benefit.

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QUESTION: Most of the currently available scientific evidence for anti-neoplastic activity of cannabinoids is derived from PRECLINICAL models, including in vitro studies and studies involving mouse models. What have the results of these PRECLINICAL studies indicated?

ANSWER: These PRECLINICAL studies have reported that THC and some other cannabinoids can activate the CB1 and CB2 receptors on the surface of cancer cells and impact the intracellular signaling pathways of the cancer cells. Some effects include (1) apoptosis of the cancer cells (2) the blockade of cancer cell proliferation (3) inhibition of tumor angiogenesis and (4) inhibition of metastasis. NOTE: the results of PRECLINICAL studies do NOT always correlate with CLINICAL outcome/benefit.

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QUESTION: Clinical trials evaluating the use of human monoclonal antibodies against interleukin 1 and interleukin 6 to treat cytokine storm syndrome in COVID-19 patients are underway or in the planning stage. Are there any possible significant pharmacodynamic interactions between monoclonal antibodies and CBD?

ANSWER: Yes. The combination of monoclonal antibody agents, including eculizumab and sarilumab, or other immuno/myelosuppressive agents with CBD may potentiate the risk of infection.

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QUESTION: Nelfinavir is an HIV-1 protease inhibitor. Patients who have HIV may be taking this drug and may also be using cannabinoids to treat some of the symptoms associated with the HIV infection. Does Nelfinavir interact with CBD? (Of note, Nelfinavir may also inhibit SARS-Cov-2 replication.)

ANSWER: The combination of Nelfinavir and CBD may lead to an increase risk of diarrhea and/or headache.

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QUESTION: Dexamethasone, a commonly used corticosteroid to treat various inflammatory conditions, has been recommended for use in COVID-19 patients with severe respiratory symptoms (according to data from Randomized Evaluation of COVID-19 Therapy (RECOVERY) trial). Does THC interact with dexamethasone? Does CBD interact with dexamethasone?

ANSWER: Both THC and CBD have possible pharmacodynamic interactions with dexamethasone. While the combination of THC and dexamethasone may lead to an increase in euphoria, the combination of CBD and dexamethasone may lead to a potentiation of immunosuppression and an increase in risk of infection, and could increase the risk of headache.

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QUESTION: Darunavir with cobicistat has been used to treat HIV and it has also been trialed for the treatment of COVID-19 infection. Are there any possible pharmacodynamic interactions between CBD and Darunavir/ Cobicistat?

ANSWER: Yes, this drug combination may increase headache and/or diarrhea.

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QUESTION: What is the most common qualifying condition reported by medical marijuana patients?

ANSWER: Currently and historically the most common qualifying condition reported by medical marijuana patients is chronic pain. In fact, according to an analysis by Boehnke et al, chronic pain was the qualifying condition reported by medical marijuana patients nearly 65 percent of the time (according to 2016 data).

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QUESTION: Hydrochloroquine has been trailed as a therapy for COVID-19 infections. Does this drug interact with CBD? If so, what are the potential consequences?

ANSWER: The combination of CBD and hydrochloroquine may lead to an increase of headache and/or diarrhea risk.

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QUESTION: Baricitnib, a drug approved for the treatment of rheumatoid arthritis, may reduce COVID-19 viral entry and mitigate inflammation. (A clinical trial evaluating this drug has begun in Italy .) Does CBD interact with Baricitnib?

ANSWER: Yes. A possible pharmacodynamic interaction between Baricitnib and CBD may develop, and there may be an increased effect on tumor necrosis factor. There may also be an increased risk of serious infection, malignancy or thrombosis.

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QUESTION: There may be pharmacokinetic and pharmacodynamic drug–drug interactions between cannabinoids and medications used to treat COVID infections. Azithromycin may have anti-viral activity and has been co-administered with hydroxychloroquine in a RCT of COVID treatment. Does Azithromycin interact with CBD?

ANSWER: Yes, a possible pharmacodynamic interaction may occur and lead to an increase risk for diarrhea.

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QUESTION: Did the number of naloxone prescriptions increase, decrease or stay the same during the time span of 2010 to 2018?
ANSWER: According to research conducted by the Urban Institute, prescriptions for naloxone increased by more than 70-fold from 2010 to 2018. (3,300 to 236,000 prescriptions). The most significant increase in naloxone prescriptions occurred after 2016.

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QUESTION: What have been the most frequently filled prescriptions at US pharmacies in 2020? Are most of them prescriptions for pain relief?

ANSWER: According to research conducted by GoodRx, an online platform that provides users with coupons for discounts on prescription drugs, the 10 most frequently filled prescriptions are: Atorvastatin, Lisinopril, Albuterol, Levothyroxine, Amlodipine, Gabapentin (for the treatment of nerve pain or seizures in adults), Omeprazole, Glucophage, Losartan, and Hydrocodone/acetaminophen (for the treatment of moderate to severe pain.)

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QUESTION: Greater social acceptance of marijuana may result in some prospective parents to reason that it could be used to treat morning sickness. Does marijuana use have any implications for fetal neurodevelopment?

ANSWER: A study evaluating the association between maternal marijuana use during pregnancy and child neurodevelopmental outcomes posed the following question: “Was there an association between cannabis exposure in pregnancy and child neurodevelopmental outcomes in a Canadian cohort?” The results of this retrospective study in Canada found that children exposed to marijuana in utero had a moderately elevated risk of developing autism spectrum disorder. Autism incidence was 4.0 per 1,000 person-years among children exposed to cannabis in pregnancy versus 2.42 among unexposed children (adjusted hazard ratio [HR] 1.51, 95% CI 1.17-1.96)

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QUESTION: In 2020, the 20 member ‘Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain’ developed recommendations for the dosing of cannabinoids. These recommendations were presented at a virtual meeting. One of their recommendations addressed the use of medicinal cannabinoids in patients with severe pain. What were the recommendations for the dosing of cannabinoids for patients suffering with severe pain?

ANSWER: According to the recommendations of the ‘Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain,’ patients suffering from severe pain and those patients who have a history of significant prior cannabis consumption can use a 50:50 CBD-THC product and start with a dose of 2.5-5 mg of each compound 1 or 2 times/day.

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QUESTION: In 2020, the 20 member ‘Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain’ developed recommendations for the dosing of cannabinoids. These recommendations were presented at a virtual meeting. One of their recommendations addressed the use of medicinal cannabinoids in elderly patients. What were the recommendations for the dosing of THC in the elderly population?

ANSWER: According to the recommendations of the ‘Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain,’ elderly patients, patients with severe co-morbidity or patients who take multiple medications should be managed through a conservative route; start with THC doses at 1 mg/day and the dose should be titrated up slowly.

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QUESTION: In 2020, the 20 member ‘Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain’ developed recommendations for the dosing of cannabinoids. These recommendations were presented at a virtual PAINWeek meeting. One of their recommendations included “Treat the majority of patients along the “routine” scale.” What does this mean?

ANSWER: Treating the majority of patients along the “routine” scale means to start with a dose of 5 mg of cannabidiol (CBD) twice daily, and tetrahydrocannabinol (THC) should only be added if the patient does not respond to at least 40 mg of CBD daily. If THC is added, the starting dose should be 2.5-mg daily. THC doses should be capped at 40 mg daily.

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QUESTION: In 2017, the National Academies of Sciences, Engineering and Medicine (NASEM) published The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. According to this report, are cannabinoids an effective treatment for chronic pain?

ANSWER: According to this report, “There is conclusive or substantial evidence that cannabis or cannabinoids are effective for the treatment of chronic pain in adults (cannabis).”

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QUESTION: Do cannabinoids decrease or increase g.i. motility?

ANSWER: The pharmacological actions of cannabinoids include decreased gastrointestinal motility, secretion, and emptying.

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QUESTION: Does dronabinol increase appetite in HIV/AIDS patients?

ANSWER: There is limited to moderate evidence to suggest that dronabinol, a synthetic pharmaceutical preparation of delta-9-tetrahydrocannabinol, may be effective in stimulating appetite and weight gain among patients suffering from HIV wasting syndrome. In 1992, the US Food and Drug Administration approved dronabinol for the treatment of AIDS-related anorexia.

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QUESTION: What is the most prevalent side effect of opioids in cancer patients?

ANSWER: Constipation is reported as the most prevalent and most disabling side effect of opioids in both cancer and non-cancer pain patients, with a prevalence as high as 90%.

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QUESTION: What are conduction-based vaporizers?

ANSWER: Conduction-based vaporizers heat herbal cannabis on a surface that is warmed, such as a metal plate, which then allows compounds to passively volatilize. Meanwhile, the consumer generates a steady inhalation, similar to the technique used by asthma patients with metered-dose inhalers or nebulizers to achieve pulmonary administration.

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QUESTION: What physiological systems are affected by the endocannabinoid system?

ANSWER: In addition to regulating neuronal excitability and inflammation in pain circuits, the endocannabinoid system has been shown to play a regulatory role in movement, appetite, hypothalamic-pituitary-adrenal axis modulation, immunomodulation, mood, blood pressure, bone density, tumor surveillance, neuroprotection and reproduction. The endocannabinoid system has also been shown to affect sensory perception, cardiac output, cerebral blood flow and intraocular pressure.

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QUESTION: What does cannabinergic mean?

ANSWER: Any drug that modifies or interacts with the endocannabinoid system is ‘cannabinergic’.

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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.

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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.

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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.

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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.

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QUESTION: Why do NSAIDS relieve pain?

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

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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?

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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.

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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: 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: 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.

–––

QUESTION: Does ketamine interact with the endocannabinoid system?

ANSWER: Yes. Ketamine induces the release of endocannabinoids.

–––

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

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

–––

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.

—

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.

—

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.

—

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.

—

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.

—

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.

—

QUESTION: Does ketamine interact with the endocannabinoid system?

ANSWER: Yes. Ketamine induces the release of endocannabinoids.

—

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

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

—

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.

—

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.

—

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.

—

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.

—

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.

Corn chips, tortillas, corn meal, grits, hominy, raw corn, corn on the cob, creamed corn, sweet corn, pop corn… there are a veritable host of corn food products.

“But I don’t eat corn!,” you may say.

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