Alabama GOP Politicians Meddle In Healthcare To Deny Treatment

Should government exercise control over its citizens to the extent that:
a.) Certain types of private health care is illegal;
b.) Certain people are denied care?

Should your neighbors (aka “the government”) have the right to tell you, and/or your family, what you can, or cannot be treated for by a licensed healthcare professional?

Suppose someone said, “Well… I don’t think you need to be treated for

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

“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

We Can Do Better

Dorothea Lange. “Nipomo, Calif. March 1936. Migrant agricultural worker’s family.
Seven hungry children and their mother, aged 32. The father is a native Californian.” Gelatin silver print, 7 3/8 × 9 5/16″ (18.8 × 23.6cm). Farm Security Administration–Office of War Information Photograph Collection, Library of Congress

Hourly Wages
Dollar General: $8
Kroger: $10
Walmart: $11
CVS: $11
Home Depot: $11
Lowe’s: $12

2020 Profits
Dollar General: $1.4 billion
Kroger: $2 billion
Walmart: $15.6 billion
CVS: $6.2 billion
Home Depot: $10 billion
Lowe’s: $4.9 billion

U.S. workers need at least $15/hr and a union.

Per capita health care spending:
Norway: $6,647
United States: $11,072

Number of uninsured/under-insured:
Norway: 0
United States: 92 million

COVID-19 deaths:
Norway (population 5.3 million): 306
Louisiana (population 4.6 million): 6,260

Yes. It is time for Medicare for All.

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https://www.WashingtonPost.com/business/2020/11/18/food-stamps-medicaid-mcdonalds-walmart-bernie-sanders/

Federal Study: Millions of Full-Time Workers Rely on Federal Health Care and Food Assistance Programs – Walmart’s and McDonald’s Employees Lead the Way

by Eli Rosenberg
November 18, 2020 at 5:02 p.m. CST

Some of the biggest and most profitable companies in the United States, including Walmart and McDonald’s, pay their employees such low wages that significant numbers of them must turn to Federal food and medical assistance.

According to a new report from the Government Accountability Office, a nonpartisan Congressional watchdog agency, made at the behest of Sen. Bernie Sanders (I-Vermont) there is a direct relationship between employers paying low wages and employees receiving the Federal assistance. The report examined February data from agencies in 11 states that administer the Federal programs Medicaid, and the Supplemental Nutrition Assistance Program (SNAP).

Walmart was one of the top four employers of SNAP and Medicaid beneficiaries in every state. McDonald’s was in the top 5 of employers with employees receiving federal benefits in at least 9 states.

The GAO research found that in the 9 states that responded about SNAP benefits — Arkansas, Georgia, Indiana, Maine, Massachusetts, Nebraska, North Carolina, Tennessee and Washington — Walmart was found to have employed about 14,500 people who were receiving benefits, followed by McDonald’s with 8,780. In six states that reported Medicaid enrollees, Walmart again topped the list, with 10,350 employees, followed by McDonald’s with 4,600.

In Georgia, for example, Walmart employed an estimated 3,959 workers who were on Medicaid — comprising an estimated 2.1% of the total of non-elderly, non-disabled people in the state who were receiving the benefit. McDonald’s was next on the list, employing 1,480 who received Medicaid, or 0.8% of the total of non-elderly, non-disabled people on the program.

In Oklahoma, 1,059 Walmart workers on Medicaid made up 2.8% of the state’s total, and McDonald’s was next, with 536 workers, or 1.4%.

In Arkansas, where Walmart was founded and maintains its global headquarters, 1,318 employees were receiving SNAP benefits — comprising 3.1% of the state’s total. McDonald’s was next on the list with 865 workers, which made for 2% of the state’s total.  And in Georgia, another 3% of SNAP recipients worked for Walmart.

The GAO report found that the next companies with large numbers of workers receiving federal benefits included Dollar Tree, Dollar General, Amazon, Burger King and FedEx. (Amazon Chief Executive Jeff Bezos owns The Washington Post.)

In a statement by McDonald’s spokeswoman Morgan O’Marra, the company claimed

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

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

Baltimore, Maryland Nursing Home Has Had ZERO COVID-19 Cases

Quite a feat, eh!?!

Amidst the turmoil, cacophony, and carnage STILL being caused by COVID-19, there stands ONE SHINING EXAMPLE of EVERYTHING that was and is being DONE RIGHT!!

“Established in 1920, the Maryland Baptist Aged Home is the oldest African-American owned and operated Nursing Home in the state of Maryland. It is governed by the Board of Trustees of the United Baptist Missionary Convention. The MBAH is a non-profit 501(c)(3) 29-bed facility providing short and long term care to all residents without regard to race, color, sex, religion or national origin. Residents served by MBAH enjoy a family oriented setting. We take a proactive approach to the development and execution of individualized resident care. We provide multi-disciplinary team approach with emphasis on respect, compassion and professionalism.”

So, now with well over 3.1 million COVID-19 cases, and untold numbers of deaths STILL occurring, in the United States from infection with COVID-19, how did they do it?

For that, we have to turn to the facility Director and CFO, Reverend Dr. Derrick C. DeWitt Sr.

The Rev. Dr. DeWitt was interviewed by Amna Nawaz of the PBS NewsHour program recently, and shared about how he accomplished such a feat.

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Amna Nawaz: So, everyone knows the numbers, right? When you look at COVID deaths in long-term care facilities around the country, they make up some 40 percent of all COVID deaths in the nation. In Maryland, I think the number is over 60 percent. How did you beat the odds?

Rev. Derrick DeWitt: Well, I think the key was early, early mitigation, early proactive steps to make sure that this disease did not enter into our nursing home.

And one of the things that I did was, I just listened to the news around the world and how this was affecting other countries. And then, when I heard — when I heard the president say, we only had 15 cases, and he thought that, by the end of the week, it would be zero. I knew that it was time that we take action.

“And again, when you have 15 people, and the 15 within a couple of days is going to be down to close to zero, that’s a pretty good job we’ve done.”
– Donald J. Trump
Remarks by President Trump, Vice President Pence, and Members of the Coronavirus Task Force in Press Conference; James S. Brady Press Briefing Room; February 26, 2020; 6:37 P.M. EST

Amna Nawaz: I don’t want to put words in your mouth, but it sounds like you basically didn’t believe the president and took early action to lock down. Is that correct?

Rev. Derrick DeWitt: Well, that’s correct, in a sense. I mean, I think us being in an underprivileged and underserved area of Baltimore City, we have kind of gotten used to the fact that, if help is going to come, it’s probably going to come too late, so we need to be prepared to take care of ourselves.

Amna Nawaz: So, tell me a little bit about what exactly you did. When you say you acted early, what steps did you put into place back in February?

Rev. Derrick DeWitt: Well, the first thing we did, probably very end of February, 1st of March, we locked down the facility. We allowed no visitors in or out.

We knew that, if the disease was going to get into the nursing home, it was going to come from the outside. And probably it was going to be an employee that brought it in.

So, we have a very rigorous screening process when they come to work. And it’s almost an hour-to-hour detail on what you did the 12 hours or 14 hours that you weren’t at work. Who did you see? Who were you with? We

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

Alabama COVID-19 Findings

Recently, I examined the Alabama Department of Public Health‘s (ADPH) COVID-19 dashboard, and made some interesting findings.

As usual with many reporting outlets, whether official, governmental, or news, there are often important underlying figures omitted, either through carelessness, or willfulness, which give understanding to the greater picture. In this instance, state population, and population percentages were missing.

According to the latest figures from the U.S. Census Bureau, as of July 1, 2019, Alabama has an estimated population of 4,903,185, and the Black or African American percentage of that population is 26.8%. Thus, when observing item numbers 1, 6, and 9 citing the percentage of Alabamians tested, and distribution of the disease as being “practically equally affected,” the reality is that because of their minority population status, the Black or African American community is affected more significantly, and disproportionately affected with respect for the total population.

As well, residents aged >65+ constitute 16.9% of the population.

Alabama has a total of 15,330 staffed beds, in 89 hospitals statewide.

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1.) Only 3.789% (almost 4%) of all Alabamians have been tested for COVID-19.

2.) Of the 551 related deaths in the state, 34.2448% were hospitalized.

3.) The majority of COVID-19 cases (39.75%, or very nearly 40%), were aged 25-49 – the “prime” of life.

4.) Those aged 65, or over, constituted only 23.67% (almost 24%) of all cases.

5.) Overall, more females than males

Which is more important – money, or life?

One again, Republicans are demonstrating their lackadaisical reckless attitude toward human life, and thereby proving that they care little, if anything, about Americans of any stripe.

Whether young, old, infant, geriatric, sick, healthy, able, disabled, veteran, civilian, Black, White, Hispanic, Asian, well-educated, poorly-educated, gay, straight, bi, gender non-conforming, or anything of all points in between – it makes no difference. Money is their god. The Almighty Dollar rules.

They and their feckless titular leader are forcing ALL Americans to bow before the altar of Mammon, sacrificing our wise elders, children, even the unborn, to the all-consuming selfish fires of commerce.

The radicalized members of the Party of Trump are your “Death Panels.” They are the very thing Republicans warned America which would happen if the PPACA were to become enacted — which is not even anything even remotely close to Single Payer/Medicare For All.

And yet, even though they’ve continually tried their damndest to kill the Patient Protection and Affordable Care Act (PPACA), aka “ObamaCare,” and every vestige of it since the day it was enacted on March 23, 2010, they’ve still not managed to come up with any alternative whatsoever.

Nada.

Bupkis.

Not only have the GOP’s dire predictions not come true, nor have they even remotely happened, but they’re still showing America what they think is TRULY important – money, money, money… MONEY!

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https://www.politico.com/news/2020/05/13/poll-coronavirus-reopen-trump-republicans-252726

Republican voters have undergone a significant shift on the coronavirus in a few short weeks.

A month ago, half of GOP voters said they were more worried about

Beef, Pork, Chicken Prices to INCREASE Significantly

Concentrated American Business Operations Spell Economic Disaster

We apparently either forgot, or didn’t learn our lessons in the events which led up to the Great Depression.

https://www.bloomberg.com/opinion/articles/2020-04-30/the-coronavirus-won-t-bring-the-end-of-big-meat-processing-plants

Colloquially, through our nation’s Federal laws governing business practice and ownership, etc., we’ve “put all our eggs in one basket.” As a result, when one factory or industry hiccups or sneezes, the entire system gets sick. The same principle is true for many other businesses and aspects of our economy.

You’ve probably read my expressions on a topic very much like this before.

“The concentration of America’s meat packing industry is ultimately a symptom of its weakness, rather than its strength.”

Despite being the world’s second-largest meat consumer after China, the U.S. slaughters almost all of its annual production of meat in just 835 facilities.

Five decades ago (in most American’s lifetimes) there were OVER 10 times as many such facilities. Anecdotally, an Epidemiologist friend share that, “Growing up in the 50’s there were dairy farms all over the South. There are very few now.”

That’s:
🐖130 million pigs
🐄33.6 million cows
🐑2.3 million sheep

If anything, those figures significantly understate how extremely concentrated the slaughter industry is.

In fact, about 66% of America’s pork is processed through 24 giant facilities owned by just 4 companies:
1.) Smithfield Foods Inc.; 2.) JBS SA; 3.) Tyson Foods Inc., and; 4.) Clemens Family Corp.

Over 80% of beef comes from just 12 abattoirs owned by 4 companies:
1.) Tyson; 2.) JBS SA; 3.) Cargill Inc., and; 4.) Marfrig Global Foods SA.

And of the two groups of meat processors which represent 50% of the meat categories consumed in America, pork and beef, 2 companies – Tyson, and JBS SA – own or control a significant portion of that market, 25%, based upon the number of competitors in the 2 categories, pork and beef.

Tyson, which is headquartered in Arkansas, is American-owned, unlike Smithfield which is headquartered in Virginia, and owned by Chinese interests. However, a full 66% of Tyson’s operations are overseas, and the company boasts that they control 20% of the entire American market share of meat by writing that “1 in 5 pounds of chicken, beef, & pork in the U.S. is produced by Tyson Foods.”

Chicken farmers are modern-day sharecroppers, and Tyson acknowledges as much by writing that, “We supply the birds and feed, and provide technical advice, while the poultry farmer provides the labor, housing and utilities.”

The North American Meat Institute (NAMI), a Washington, D.C. based lobbying organization for the major players in the corporate-owned industrialized meat industry – NOT mom & pop-owned Family Farms, which are increasingly rare – writes this on their website about the meat industry in America:

Billionaire Explains Why and How Capitalism Needs to Be Reformed

linkedin.com

Why and How Capitalism Needs to Be Reformed (Parts 1 & 2)

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Published on April 5, 2019April 5, 2019

By Ray Dalio

Co-Chief Investment Officer & Co-Chairman of Bridgewater Associates, L.P.

Summary

I was fortunate enough to be raised in a middle-class family by parents who took good care of me, to go to good public schools, and to come into a job market that offered me equal opportunity. I was raised with the belief that having equal opportunity to have basic care, good education, and employment is what is fair and best for our collective well-being. To have these things and use them to build a great life is what was meant by living the American Dream.

At age 12 one might say that I became a capitalist because that’s when I took the money I earned doing various jobs, like delivering newspapers, mowing lawns, and caddying and put it in the stock market when the stock market was hot. That got me hooked on the economic investing game which I’ve played for most of the last 50 years. To succeed at this game I needed to gain a practical understanding of how economies and markets work. My exposure to most economic systems in most countries over many years taught me that the ability to make money, save it, and put it into capital (i.e., capitalism) is the most effective motivator of people and allocator of resources to raise people’s living standards. Over these many years I have also seen capitalism evolve in a way that it is not working well for the majority of Americans because it’s producing self-reinforcing spirals up for the haves and down for the have-nots. This is creating widening income/wealth/opportunity gaps that pose existential threats to the United States because these gaps are bringing about damaging domestic and international conflicts and weakening America’s condition.

I think that most capitalists don’t know how to divide the economic pie well and most socialists don’t know how to grow it well, yet we are now at a juncture in which either a) people of different ideological inclinations will work together to skillfully re-engineer the system so that the pie is both divided and grown well or b) we will have great conflict and some form of revolution that will hurt most everyone and will shrink the pie.

I believe that all good things taken to an extreme can be self-destructive and that everything must evolve or die. This is now true for capitalism. In this report I show why I believe that capitalism is now not working for the majority of Americans, I diagnose why it is producing these inadequate results, and I offer some suggestions for what can be done to reform it. Because this report is rather long, I will present it in two parts: part one outlining the problem and part two offering my diagnosis of it and some suggestions for reform.

Why and How Capitalism Needs to Be Reformed

Before I explain why I believe that capitalism needs to be reformed, I will explain where I’m coming from, which has shaped my perspective. I will then show the indicators that make it clear to me that the outcomes capitalism is producing are inconsistent with what I believe our goals are. Then I will give my diagnosis of why capitalism is producing these inadequate outcomes and conclude by offering some thoughts about how it can be reformed to produce better outcomes.

Part 1

Where I’m Coming From

I was lucky enough to

America! You’re GROWING!!! GET COUNTED! Because SIZE MATTERS!

Here are a few factoids for your entertainment.

• There are SO FEW people in Wyoming, that they have enough room on their automobile license plates to depict a cowboy on a bucking bronco… and STILL have plenty of room leftover for numbers & letters for EVERY car in the state.

• There are MORE people in Nashville, TN (669,053) than there are in Wyoming (578,759).

• There are MORE people in Tennessee (6,829,174) than there are in Colorado (5,758,736).

• The TOTAL number of students (13,131), faculty, and staff (9,253) at Vanderbilt University, and employees at the now-independent University Medical Center (24,039) totals 46,423, which, in effect, makes it a city unto itself, and is why the University (and MC) have the state’s ONLY state-certified police force, with full authority to perform EVERY law enforcement function of the state. They’re also voluntarily, and fully accredited by three law enforcement accrediting bodies, one international, one national, one state:

• CALEA (Commission on Accreditation for Law Enforcement Agencies)
• IACLEA (International Association of Campus Law Enforcement Administrators)
• TLEA (Tennessee Law Enforcement Accreditation)

Here’s a factoid sheet on VUMC (Vanderbilt University Medical Center).

Speaking of size (because, yeah… size matters!), we’re growing! And by “we” I mean to refer to the United States.

For example, did you know that: → Population Rank

• Denver’s population is 716,492. → 19

• Atlanta, GA’s population is 498,044. → 37
(And was once called the “New York” of the South.)

• Jacksonville, FL = 903,889 → 12
• Fort Worth, TX = 895,008 → 13
• Columbus, OH = 892,533 → 14
• San Francisco, CA = 883,305 → 15
• Charlotte, NC = 872,498 → 16
• Indianapolis, IN = 867,125 → 17
• Seattle, WA = 744,955 → 18
• District of Columbia = 702,455 → 20
• Boston, MA = 694,583 → 21
• Detroit, MI = 672,662 → 23
• Portland, OR = 653,115 → 25
• Memphis, TN = 650,618 → 26
• Fresno, CA = 530,093 → 34

Comparatively, these cities’ names, while familiar, might conjure up population pictures that are not necessarily what one might imagine.

For example, who would’ve thought that San Francisco (883,305) and Charlotte (872,498) are almost identically populated? Size Rank → 15, 16

Or Denver (716,492) and Nashville (669,053)? →  19, 24
Or Boston (694,583) and El Paso (682,669)? → 21, 22
Or Las Vegas (644,644) and Louisville, KY (620,118)? → 28, 29
Or Atlanta (498,044), and

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.

How can I know if I’m FULLY recovered from COVID-19 novel coronavirus?

We were discussing this – how to determine if someone is fully recovered – just moments earlier BEFORE I happened upon this news item.

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https://www.mprnews.org/story/2020/04/01/mayo-clinic-expects-covid19-antibody-test-to-be-ready-monday

“Researchers at Mayo Clinic expect to release a test that would tell whether a person has

USA Now Has MORE COVID-19 Coronavirus Cases Than China Ever Did

I can hear it now –– the chants of the Faux Noize talking head dingbats saying loudly in unison… “We’re number 1! We’re number 1!”

According to information as of 0600 CST DST Friday, 27 March 2020, provided through Johns Hopkins University Dashboard, the United States has 85,991 active and confirmed COVID-19 coronavirus cases, while China – which has 1 BILLION MORE PEOPLE, has NOT reported any additional, or new cases – experienced 81,894 such cases.

So, let’s put this in perspective, shall we?

The United States Census Bureau reports that American Population is estimated be very nearly 330,000,000 – 330 million.

Chinese Population is estimated to be 1,389,618,778 – that’s 1 BILLION, 389 million, 618 thousand, 778.

India’s Population is estimated to be 1,311,559,204.

The US Population is only 23.7475% that of China.

Or, expressed another way, China has 321.0965% MORE people than the United States.

So… WHY is it that the United States has 5.0028% MORE COVID-19 infection cases than China?

Seriously…

WHY!?!

WHAT has been done, or what has happend which has led us to this point?

Well… that’s an EXCELLENT question!

The POTUS – that’s Donald John Trump – has killed, slashed and burned, many biosecurity programs which would have helped protect American Public Health.

Here’s what Forensic News wrote:

“On his second full day in office President Trump instituted a federal hiring freeze that stayed in place for nearly 90 days. In the weeks after the freeze was lifted, nearly 700 positions sat vacant at the Centers for Disease Control and Prevention (CDC). According to researchers and officials interviewed in May 2017, the freeze affected “programs supporting local and state public health emergency readiness, infectious disease control, and chronic disease prevention.

“Many of the unfilled jobs are high-level positions, at least GS-12 and above… Several positions are in the Office of Public Health Preparedness and Response, which regulates some of the world’s most dangerous bacteria and viruses and manages the nation’s stockpile of emergency medical countermeasures. Others include positions in the director’s office, infectious disease offices and the office for noncommunicable diseases, injury and environmental health.

”To make matters worse, the Trump administration took months to fill numerous senior positions that are critical to responding to an outbreak. A permanent Director of the CDC was not appointed until July 2017, six months after taking office, and the top position at the U.S. Agency for International Development (USAID) remained empty for nearly eight months. Second-in-command positions also remained empty across health-related agencies: Within the Department of Health and Human Services (HHS), there was no Assistant Secretary for Health for over a year, no Assistant Secretary for Preparedness and Response for eight months, and no Director of the Office of Global Affairs for five months. USAID just received its first permanent deputy administrator last year, in 2019!

“In addition to the dissolution of global health security units, the NSC has experienced unprecedented turnover during Trump’s administration. There have been four National Security Advisors (in addition to two acting NSAs) in Trump’s three years in office. This is compared to Barack Obama’s three NSAs in eight years and two in George W. Bush’s eight years. Trump has had five Deputy National Security Advisors in 3 years, while Obama had four in eight years and W. Bush had three in eight years. Trump has had four Homeland Security Advisors (plus one acting HSA) in three years compared to two in Obama’s eight years and four in W. Bush’s eight years. “

But WAIT!
THAT’S NOT ALL!

Yeah… you guessed it.

It’s POS45’s fault.

The BUCK STOPS with him.

Or… does it?

“Yeah, no, I don’t take responsibility at all, because we were given a set of circumstances and we were given rules, regulations, and specifications from a different time. It wasn’t meant for this kind of an event with the kind of numbers that we’re talking about.”
–– POTUS Donald John Trump, Friday, 13 March 2020, White House Rose Garden news conference

POTUS Harry Truman succeeded to the Office of the President upon the death of POTUS Franklin Delano Roosevelt, who died in his FOURTH term in office.

“The President is merely the most important among a large number of public servants. He should be supported or opposed exactly to the degree which is warranted by his good conduct or bad conduct, his efficiency or inefficiency in rendering loyal, able, and disinterested service to the nation as a whole. Therefore it is absolutely necessary that there should be full liberty to tell the truth about his acts, and this means that it is exactly necessary to blame him when he does wrong as to praise him when he does right. Any other attitude in an American citizen is

RNs Being Begged to Work in COVID-19 States With Little PPE. Trade Money for Your Life?

COVID-19 novel Coronavirus is no laughing matter, and is rapidly overwhelming hospitals nationwide, especially in New York City, which has become the practical epicenter of the global pandemic in the United States.

In response, physicians are being requested to come out of retirement to assist states where the effects of the almost instantaneous demand for licensed healthcare professionals are being experienced the worst. Some for love, others for money.

And, as one might expect, Registered Nurses are in great demand as well, the shortage of which is being keenly and acutely felt. As a result, Travel Nurse agencies are placing calls nation-wide for RNs to assist in localities hardest hit, which include Washington state, California, and New York City.

The compensation packages which are being offered in response are nothing less than eye-popping, with almost “stupid money” being paid for RNs to work – however briefly – in hospitals where needs exist.

An unexpected problem has arisen, however, and that is an acute shortage of Personal Protective Equipment (PPE), which includes gowns, gloves, nose/mouth masks (especially N95 respirators), and eye shields. If the healthcare providers do NOT have the proper equipment to care for patients, their lives will be placed at risk, as well.

In essence, one is being asked to risk their life for money – and unnecessarily. Already, there are widely circulated national news reports of some staff in some facilities reusing such PPE, which is designed for ONE USE ONLY, which is also required by law and/or regulation for the health and safety of staff and patients.

Examples of how, and where they’re being recruited (including internationally), and the compensation packages include:

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, 18 January 2021
This page is updated regularly, typically, at least once weekly.

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

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

So in that sense, enjoy!

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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

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

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

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

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

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

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

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

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QUESTION: What are K2 and Spice?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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QUESTION: What are common street names for marijuana?

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

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QUESTION: What is hashish?

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

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

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

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QUESTION: Does marijuana use alter the sexual intercourse experience?

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

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

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

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

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

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QUESTION: Does ketamine interact with the endocannabinoid system?

ANSWER: Yes. Ketamine induces the release of endocannabinoids.

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

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

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

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

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

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

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

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

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

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

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

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

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QUESTION: What medications alleviate the symptoms of marijuana withdrawal?

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

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QUESTION: What does “broad spectrum” mean?

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

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

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

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

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

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

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

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

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

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

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

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QUESTION: Are pupillary responses to light affected by marijuana?

ANSWER: Yes – marijuana may impair pupillary responses.

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

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

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QUESTION: What is the definition of drug diversion?

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

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

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

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

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

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

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

–––

QUESTION: Does CBD modulate 5-HT1A receptor activity?

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

–––

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.

–––

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.”

–––

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.

–––

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.

–––

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.

–––

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.”

–––

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.

–––

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.

–––

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.

—

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.

Trump Budget Slashing Gutted Coronavirus Emergency Response

Trump’s hated of “everything Obama” has already harmed America.

Now, it’s harming Public Health.

That man is a genuine threat to the security of the United States. He simply has NO understanding of the complexity of the matters placed before him on the platter of the Presidency. He is utterly out of his league.

Consider this sampling of inane things he’s said about coronavirus (COVID-19):

First, it was, “We have it all under control.”

Followed closely by, “It’s very small problem in this country.”

And on its heels was, “The Coronavirus is very much under control in the USA.”

Which was later accompanied by, “We have it totally under control. It’s going to be fine.”

As things progressed, and it because clear that it was only a matter of time before Americans were affected, he said in Davos, Switzerland that, “We do have a plan, and we think it’s going to be handled very well.”

Now that the fecal matter has started to hit the fan, he decided to make a rare, live, emergency telecast to address the nation, and said that, “I have decided to take several strong but necessary actions to protect the health and well-being of all Americans.”

He also said in that emergency live telecast address to the nation that, “We declared a public health emergency and issued the highest level of travel warning.”

In the same breath, he said, “To keep new cases from entering our shores, we will be suspending all travel from Europe to the United States for the next 30 days.”

Just last year, he:
• Cut the budgets of the Centers for Disease Control, and other Public Health-related budgets,
• Firing the government’s entire pandemic response chain of command, including those of the
––National Security Agency,
––National Security Council,
––Health and Human Services,
––Department of Homeland Security,
• Gutting the entire management infrastructure of the White House, and
• Killing the Complex Crises Fund

…DESPITE all that budget bloodshed like Sweeney Todd, The Demon Barber of Fleet Street, he had the unmitigated gall and audacity to say that, “We are at a critical time in the fight against the virus.”

And sadly, it’s highly doubtful that anyone truly believes him when he said, “I will always put the well-being of America first.”

It’s not as if anyone believes him now, anyway. Members of the Cabinet are in fear of him, that they’ll lose their jobs being fired by Tweet, so they simply turn into jelly, and keep their ideas to themselves… since he knows how to run everything, anyway. So what difference does it truly make?

The next thing is to GET HIM OUT OF OFFICE!

But, moreover, this article goes in-depth to show and explain the things he’s done which have had a horrific effect upon Public Health -and- National Security.

That is NOT how to “Make America Great Again.”

Come November, you know what to do.

VOTE HIM OUT!!!

Trump Has Sabotaged America’s Coronavirus Response

By Laurie Garrett
January 31, 2010
https://foreignpolicy.com/2020/01/31/coronavirus-china-trump-united-states-public-health-emergency-response/

When Tedros Adhanom Ghebreyesus, the director-general of the World Health Organization (WHO), declared the Wuhan coronavirus a public health emergency of international concern on Thursday, he praised China for taking “unprecedented” steps to control the deadly virus. “I have never seen for myself this kind of mobilization,” he noted. “China is actually setting a new standard for outbreak response.”

The epidemic control efforts unfolding today in China—including placing some 100 million citizens on lockdown, shutting down a national holiday, building enormous quarantine hospitals in days’ time, and ramping up 24-hour manufacturing of medical equipment—are indeed gargantuan. It’s impossible to watch them without wondering, “What would we do? How would my government respond if this virus spread across my country?”

For the United States, the answers are especially worrying because the government has intentionally rendered itself incapable. In 2018, the Trump administration fired the government’s entire pandemic response chain of command, including the White House management infrastructure. In numerous phone calls and emails with key agencies across the U.S. government, the only consistent response I encountered was distressed confusion. If the United States still has a clear chain of command for pandemic response, the White House urgently needs to clarify what it is

If the United States still has a clear chain of command for pandemic response,
the White House urgently needs to clarify what it is – not just for the public but for the government itself,
which largely finds itself in the dark.

When Ebola broke out in West Africa in 2014, President Barack Obama recognized that responding to the outbreak overseas, while also protecting Americans at home, involved multiple U.S. government departments and agencies,

Would You Visit A Cuban Beach?

Suppose that one day, you were on the beach in Varadero Beach, which is slightly EAST of Havana, Cuba, or in some other scenically tropical locale in that Caribbean island nation.

And on that day, suppose that it was a lovely sunny day, with pretty puffy white clouds floating around, the temperature was a balmy 82ºF, and a gentle breeze was blowing across the Gulf of Mexico onto the beach where you were located.

You’d probably say that it’d be an idyllic setting, for sure. Maybe even a picture perfect day on a lovely sandy-white beach!

Agree?

Now, suppose that you returned home and you said to your friends, “Wow! What a beautiful day it was on the beach in Cuba! It was a wonderfully lovely sunny day, clear skies, with a mild breeze, and 82ºF. It was absolutely PERFECT!”

And then… just as the words left your mouth, your friends started to call you a “communist sympathizer” simply because you told them how beautiful and perfect a day it was while you were on the beach in Cuba.

It’d be absurd, wouldn’t it?

And you’d think they were at least two bricks shy of a load – right?

In essence, that’s what some are doing to Bernie Sanders.

Simply because

What is Democratic Socialism?

Bernie Sanders has continually explained and made the case why he calls himself a democratic socialist, and corrects those who decry his self-described identity as a democratic socialist. Opponents from within, and without the party have viciously maligned him for that.

Vermont Senator Bernie Sanders – I , official portrait

In essence, it’s caring for your fellow citizen just like they’re your family. And that includes being humanitarian, and caring for others, treating them with the dignity, honor, and respect inherently and rightly due every human being.

Listening to him speak of the principles he addresses, for those with a Christian, or religious knowledge, or background, it reminds me of the principles mentioned following Judeo-Christian Scripture verses. Oh, for those who consider Jews as God’s special, or chosen people… Bernie is a Jew. Could his voice be that of a prophet, of one crying in the wilderness?

“Where there is no vision, the people perish.”¹

“The laborer is worthy of their hire.”²

“Do not muzzle the ox that treads the grain.”³

“‘Administer true justice. Do not oppress the widow or the fatherless, the foreigner or the poor. Do not plot evil against each other.'”⁴

“You must not oppress, or defraud your neighbor nor rob him. The wages due a hired hand must not remain with you until morning.”⁵

“Do not oppress a hired worker who is poor and needy, whether he is a brother or a foreigner residing in one of your towns.”⁶

“Now if your countryman becomes destitute and cannot support himself among you, then you are to help him as you would a foreigner or stranger, so that he can continue to live among you.”⁷

“You must not exploit or oppress a foreign resident, for you yourselves were foreigners in the land of Egypt. You must not mistreat any widow or orphan.”⁸

“He defends the cause of the fatherless and the widow, and loves the foreigner residing among you, giving them food and clothing.”⁹

“But I will be merciful only if you stop your evil thoughts and deeds and start treating each other with justice; only if you stop exploiting foreigners, orphans, and widows; only if you stop your murdering; and only if you stop harming yourselves by worshiping idols.”¹⁰

¹Proverbs 29:18
²1 Timothy 5:18
³Deuteronomy 25:4
⁴ Zechariah 7:9,10
⁵ Leviticus 19:3
⁶ Deuteronomy 24:14
⁷ Leviticus 25:35
⁸ Exodus 22:21,22
⁹ Deuteronomy 10:18
¹⁰Jeremiah 7:5

––//––

Bernie Sanders fires back at Trump over socialism
CNN Sanders Town Hall
Feb 25, 2019
During a CNN town hall, Democratic presidential candidate Bernie Sanders explains the programs he’d like to implement if he were elected president, which have been criticized by President Trump as akin to socialism.
https://youtu.be/tJ9j_JT9Lhg

In response to a question asked by an audience member, Bernie Sanders said in part…

“We have political rights… freedom of religion – and all of that is enormously important. But you know what we don’t have? We don’t have guarantees regarding economic rights. And way back in 1944, and in a little-known, little-publicized State of The Union speech, Franklin Delano Roosevelt said something, and – I’m paraphrasing him – but he said, ‘you know, when we talk about human freedom, and rights, we’ve got to understand that everybody needs a decent-paying job, that people need healthcare, that people need education.’

Will You Release Your Medical Records?

Just in the case you may not know it, there’s a law in our United States called HIPAA, which is the acronym for the Health Insurance Portability and Accountability Act.

Signed into law in 1996 by then-POTUS Bill Clinton, the long title is “An Act To amend the Internal Revenue Code of 1996 to improve portability and continuity of health insurance coverage in the group and individual markets, to combat waste, fraud, and abuse in health insurance and health care delivery, to promote the use of medical savings accounts, to improve access to long-term care services and coverage, to simplify the administration of health insurance, and for other purposes.”

The biggest takeaway from the bill for most people is the privacy it mandates for patient’s medical records, care, and treatment. With fines/penalties for violation starting at $250,000 per violation, an entire industry has grown up around HIPAA.

The Department of Health and Human Services summarizes, in part, the law’s privacy provisions:

“The Health Insurance Portability and Accountability Act of 1996 (HIPAA) required the Secretary of the U.S. Department of Health and Human Services (HHS) to develop regulations protecting the privacy and security of certain health information.¹ To fulfill this requirement, HHS published what are commonly known as the HIPAA Privacy Rule and the HIPAA Security Rule. The Privacy Rule, or Standards for Privacy of Individually Identifiable Health Information, establishes national standards for the protection of certain health information. The Security Standards for the Protection of Electronic Protected Health Information (the Security Rule) establish a national set of security standards for protecting certain health information that is held or transferred in electronic form. The Security Rule operationalizes the protections contained in the Privacy Rule by addressing the technical and non-technical safeguards that organizations called “covered entities” must put in place to secure individuals’ “electronic protected health information” (e-PHI). Within HHS, the Office for Civil Rights (OCR) has responsibility for enforcing the Privacy and Security Rules with voluntary compliance activities and civil money penalties.”

POTUS Bill Clinton Signing HIPAA

Before the HIPAA existed, there were no security standards nor requirements to protect patients’ health information or patients privacy in the entire health care industry. In reality, physicians, or anyone with access to the record – including the janitor and housekeeping crew – could simply access and divulge a patient’s entire medical record to the press, or to anyone, without any legal recourse for the victim. Now, it’s a violation of the law to even discuss any Personal Health Information, or Personally Identifying Information about the patient outside of a clinical setting, and that includes on elevators in hospitals. The law is so strict, that anyone who is not involved in the patient’s care cannot access the patient’s record without violating the law.

There have been cases where renown individuals, or those with celebrity status, including politicians, have had their records accessed by those within the healthcare system in violation of the law, ostensibly to satisfy their 24karat curiosity, or for other nefarious purposes, such as to gossip about the patient, or to divulge the information they found to the press. Healthcare organizations, especially large ones, are particularly sensitive to such violations of the HIPAA, and many, if not most, have policy in place to censure, or most often, dismiss for cause (fire) any employee who examines a record of a patient whom they’re not treating, or caring for.

In short, the law safeguards and protects patients’ right to privacy of their healthcare information in ways the average patient cannot imagine, including transmission of such information electronically, such as via facsimile or Internet.

The law also provides authorization for a patient to request a healthcare organization voluntarily release select portions of, or their entire medical records, to individuals whom they specify, such as to attorneys who may be representing their interests in a matter of law, including to the patients themselves, personally.

What many may not know about the law, is that it was a bipartisan bill sponsored by

Poll: Americans Unhappy With Abortion Laws

New polling released by Gallup shows that “Fifty-eight percent of Americans say they are dissatisfied with the nation’s policies on abortion, marking a seven-percentage-point increase from one year ago and a new high in Gallup’s trend.”

Gallup released the findings of their research from a

The GOP Hopes That You Keep Sleeping

America has become like the proverbial frog in a pot of water, which has slowly, but steadily, increased in temperature to the point that it is boiled alive without realizing it.

As the story goes, if the frog were dumped into boiling water, it would immediately jump out.

But, since the water’s temperature was initially comfortable, even pleasant, and only slowly increased, the frog gradually became acclimated to it, and therefore was, in effect, desensitized to the inevitable, impending danger, and died slowly.

For the past nearly 50 years or so, and more specifically, within the last 38, America has swooned under the siren song led by the GOP, which in part started off with the not-so-oblique condemnation that, “In this present crisis, government is not the solution to our problem; government is the problem.” (As Brian Gurney, a private citizen from California, noted: “You can’t govern if you don’t believe in government.” But set up a straw man, and beat it to a pulp – demonize the Constitutional effigy.) And to sweeten the deal, and help matters along, a little bit of “They’re individuals and families whose taxes support the government and whose voluntary gifts support church, charity, culture, art, and education. Their patriotism is quiet, but deep. Their values sustain our national life,” was thrown in for good measure (“a spoonful of sugar helps the medicine go down,” you know).

In order to facilitate that destruction, first was an appetizer of dessert – across-the-board personal income tax rates were cut 23%, which made the majority of working-class Americans and families very happy.

But then, calling them “job creators,” (veritable sacred cows which should be left alone to wander about in traffic and poop anywhere they desire) another round of personal income tax cuts came around, this time for the elites, and personal income tax rates upon the very wealthiest Americans was dramatically slashed to less than half the former rate – from 70% to 28%.

And then, there came cries and demands for liberty, and freedom from the tyranny of genuine governmental slavery in the form of, “Mr. Gorbachev, tear down this wall!” And truly, who could disagree? But that was quickly transformed into efforts to squelch personal liberty as healthcare decision-making in the most intimate of, and deeply personal matters involving reproduction, by providing opportunity for nosy neighbors (government) to tell others how they ought to run their lives according to the dictates of others’ religious convictions, all under the auspices of government.

Dissatisfied with that aspect of control, they sought to again meddle into the private lives of others – despite the fact that their private liberties were not encroached upon – and the sanction of committed legal relationships in the civil sector were forbidden to select individuals… just like it once was with ethnic minorities. And when in indignation they invited the SCOTUS to step in and rule (hopefully to their advantage, though contrary to their own religious writings), which ruled against their religiously-motivated (no religious test), publicly-sanctioned governmental discrimination (equal protection under law), they loudly cried ‘FOUL!’

And then, when more of their hand-picked, fair-haired children ruled against them, that rights were not absolute (D.C. v Heller), that not just anyone had a right to own, possess, or brandish any firearm, anywhere, at any time, they couldn’t stand it any more, and falsely accused the SCOTUS of partiality and of siding with their opponents whom they continuously maligned, despite the fact that they were ruled against by one of their own most staunch hard-liners.

Feeling emboldened, their most powerful, yet little-known instigator went public and said in part that,

In Praise of Regulation

It’s said that “power corrupts, and absolute power corrupts absolutely.”

Though Lord Acton (John Emerich Edward Dalberg Acton (1834–1902), the first Baron Acton) is often attributed with originating that phrase in an 1887 letter to Bishop Mandell Creighton, the idea itself was not new to him, and was known to have been expressed in 1770 by in a speech to the UK House of Lords by William Pitt the Elder, Earl of Chatham, who was British Prime Minister 1766–1778.

Our nation’s Founders understood that principle quite well, as evidenced by the systems of oversight, and the establishment of three separate, co-equal branches of government which they established via the Constitution – which was ratified June 21, 1788.

Absolute power, in a market sense, is about money and corrupting influence that almost always accompanies unchecked concentrated power. In this era, we see it commonly as a desire to abolish rules, regulations, and laws designed to protect the people.

That’s but one underlying reason why the GOP wants to abolish “ObamaCare” – so that power (and money) may be concentrated in the hands of the already-powerful.

We the people have the final say-so, because

Economic Fundamental

California United States Senator Kamala Harris

There is something FUNDAMENTALLY WRONG in a nation when its largest supermarket chain by revenue – which is also the second-largest general retailer and the eighteenth largest company in the nation – finds it necessary, and plans to

Alabama To Join Nursing License Compact

Hooray for Alabama!

Their legislature can always be counted upon to do the right thing… only after they’ve exhausted every other possibility.

Alabama State Representative April Weaver, a Republican from House District 49, representing parts of Bibb, Chilton, and Shelby counties, has introduced HB44, which “would allow the Board of Nursing to enter into the Enhanced Nurse Licensure Compact as a means of providing uniformity in licensing requirements and interstate practice throughout party states. This bill would also amend existing law to make technical corrections relating to the multistate licensure of nurses.”

For those unfamiliar with the eNLC, think of it like a Driver License.

Your license to drive is valid in 49 other states. And if you’re driving in another state and are given a traffic citation by any Law Enforcement Officer for a moving violation such as

Healthcare, Marijuana, Medicare For All, Voting Rights, And More

This prospective legislation (linked below) is “…an indication of the overall appetite for progressive policies in the 2020 Democratic primary race.”

And, it’s about damn time!

Vermont Senator Bernie Sanders -I

I’m sick & tired of hearing folks say that there’s not a nickel’s worth of difference between the Democrats and the Republicans. And face it… if it weren’t for Bernie leading the way last General Election cycle, we very likely wouldn’t be hearing this kind of talk. Seriously.

 

And, while Sen. Kamala Harris exceeded Bernie’s 2016 fundraising “haul” by raising $1.5M in the first 24 hours following announcement of candidacy, Bernie outdid himself this time by raising $6M in 24 hours. THAT is SIGNIFICANT! And, it says that the number of those who believed in him last time, have increased. Plus, he already has the campaign people and mechanisms in place, whereas others – including Harris – do not.

California Senator Kamala Harris -D

I think it’ll be interesting to see how all this shakes out.

Of course, Joe Biden’s likely to be tossed into the mix, but while polls show he has “favorable” ratings with many, including Republicans,

How the Sackler family, private owners of OxyContin maker Purdue Pharma, became America’s BIGGEST drug pushers.

NPR, along with a few other news reporting agencies, has today published a story detailing how the Sackler family – with an estimated net worth of $13 Billion and listed by Forbes as the 19th wealthiest family in the United States – whose privately-held Purdue Pharma falsified, neglected, and purposely withheld information, and aggressively peddled their habit-forming narcotic medication branded as “OxyContin” to physicians, hospitals, and medical colleges as an acceptable, even benign medication for pain relief, despite overwhelming evidence to the contrary.

Purdue Pharma President Richard Sackler, and wife Beverly are the biggest narco-traffickers in the United States.

In a 274 page filing, the Massachusetts Attorney General, Maura Healey, carefully detailed how the Sackler family carefully and deliberately manipulated, and crafted opportunities with Massachusetts’ legislators, regulators, and others, to sell increasing volumes of the narcotic medicine.

The documents state that in a 2-15-2011 email, after one week of prescriptions doubled the company’s profit forecasts, Richard Sackler wrote to the sales staff that “I had hoped for better results.”

Massachussetts Attorney General’s Office pre-hearing memo & exhibits

https://d279m997dpfwgl.cloudfront.net/wp/2019/01/Mass_AGO_Pre-Hearing_Memo_and_Exhibits.pdf

But here’s where an otherwise LEGAL pharmaceutical firm became complicit with international narco-traffickers and street-level drug pushers, rapidly escalated America’s Opioid Crisis, and in the process became equals with terrorists like al Qaeda and the Taliban.

The Massachusetts Attorney General Pre-Hearing memorandum cited a

Can I ask you a question?

Here’s but one story from my storied career.

—//—

Once, upon a time, I worked in a CVICU (CardioVascular Intensive Care Unit) in Greenville, MS – a predominately Black populated area, with high poverty, and all the problems that come along for that ride.

A patient came to us from a SNF (Skilled Nursing Facility, i.e., Nursing Home), and was refusing to communicate/talk with staff. I became his Nurse. He was a Black gent, and I cared for him just like I would for anyone else – with dignity, and empowering them to make decisions regarding their care.

I was working

A Guide To Increasing Company Value

Almost everyone who has worked in sales has heard the mantras “the customer is always right,” and “the customer is your most important person.”

And as anyone who has worked in healthcare can attest, neither of those statements are true.

For example, consider the patient who, arriving at the ED (Emergency Department) said to the physician, “My doc says my sugar is high so he gave me this medicine for diabetes.”

Naturally, the physician asked, “Do you take it?”

The patient replied saying, “No, ’cause I don’t have diabetes, just high sugar.”

And then, another Physician who explained to the patient’s mother her child’s diagnosis and therapeutic interventions saying, “She has a concussion, she needs to rest in bed in a quiet dark room until she is better.”

The mother then asked, “Can she go to the fair?”

Conventional wisdom often monikered as “common sense,” sometimes follows the pithy axiom that “common sense isn’t so common anymore.”

For years, I’ve maintained that the customer is NOT “always right,” nor are they the “most important person” in any business.

Instead, the most important person in any business are the employees.

Some CEOs have gotten a bad rap, often justifiably, because while seeking to return corporate profit and shareholder return, they’ve cut resources and employees. Like the abusive Pharaoh of the Exodus account in the Old Testament, they demand to “make more bricks with less hay.” Of course, we know how that story ended – not well.

So naturally, it delighted me to read some time ago that Sir Richard Branson, a renown entrepreneur and philanthropist, has similarly long held that thought and said, “Put your staff first, customers second, and shareholders third.”

In a 2014 interview with Inc. magazine, Sir Richard said,

I’m Thinking About Suicide

Ever thought about suicide?

Many have.

And not all of them are depressed.

Some are epidemiologists – folks whose business it is to think about the source, causes, and prevention of disease. And then, other health professionals such as physicians, Nurses, psychologists, social workers, and others think about suicide – again, not as means to end their own lives, but for the sake of others. And yet Nurses and physicians also personally think about suicide, and often at rates greater than the average population.

I’ve thought about suicide.

I’ve thought about suicide many times.

In fact, I’m thinking about suicide as I write this entry.

But I’m not thinking about suicide as a means to end my own life.

I’m thinking about suicide because…

Apple Appeals to the “Help! I’ve fallen and I can’t get up!” Crowd

With it’s new Watch Series 4, Apple Computer of Cupertino, CA has signaled its intent to capitalize upon integrating electronics, health informatics, and aging.

With one fell swoop, Apple has exemplified and cemented the “Help! I’ve fallen and I can’t get up!” era.

Long thought of as a popular cultural icon, the phrase “I’ve fallen and I can’t get up!” entered American vernacular in 1989 and quickly became a comedic touchstone which endures to this day.

The LifeCall company advertised their medical alarm product on television, which was shown being worn as a pendant or brooch (primarily marketed toward women), and which could be activated by pushing a single button on the device which in turn, called the firm’s 24-7/365 operators in the event of the wearer’s immobility… presuming, of course, that they were fully alert, and capable of pressing a button.

By October 1990, LifeCall had patented the phrase “I’ve fallen and I can’t get up!” and with various minor modifications, as time progressed, by 2007, the phrase had become their legally official trademark.

Falls, of course, result many causes, not the least of which may be

Why does America need a Single Payer Healthcare option?

America and American industry, its entrepreneurship and ingenuity, needs a Single Payer Healthcare option for the same reason America’s military service members -and- their families have 100% all-expenses paid healthcare.

Why is that?

Because a sick military service member can neither train, nor fight, nor perform their mission (work/do their job), neither can they work/train if they’re worrying about their family – who’ll care for them, how they’ll get well, if they can pay for the care/treatment, etc.

Furthermore, it’s also a matter of National Security to provide 100% of all healthcare services at no cost to them because if they’re wondering how they’ll pay for healthcare, they might think of looking elsewhere for money, and thereby could become tempted to compromise security by divulging secrets, or working for an enemy.

Already, America is NOT the “healthiest” nation in the world, neither do we have the best healthcare nor healthcare system in the world. In fact, the overall performance or level of Americans’ national level of health, according to the latest research published in

Trump: Who Voted For, And Supports Him?

Formerly titled, “With Trump WYSIWYG: Who Voted For, And Supports Him?”

African leopard, Panthera pardus pardus, near Lake Panic, Kruger National Park, South Africa, 31 December 2013
Attribution 2.0 Generic (CC BY 2.0), Derek Keats, https://www.flickr.com/photos/93242958@N00/19448654130M

One either loves, or loathes, Donald Trump.

One does not simply “tolerate” him.

He is a divisive political figure.

He is starkly contrasted to former POTUS George W. Bush, who in a May 6, 1999 interview with David Horowitz of Salon magazine, famously said, “I’m a uniter, not a divider.”

Trump is a divider, not a uniter.

For Trump, e pluribus unum means nothing, even though we are the United States of America.

And for those who voted for him thinking he’d change, that he was merely spouting hollow campaign rhetoric, they might as well have asked a leopard to change it’s spots.

With Trump, WYSIWYG.

Specifically, I mean to refer to him in his executive Presidential capacity.

And yet, strangely enough, he has coalesced support from diverse, divergent sub-groups within, and without the GOP. The importance of that feat cannot, and should not be underestimated, glossed over, or minimized, because understanding it is key to political success, especially for

11 Year Study Finds Opioid Deaths Down In Medical #Marijuana States

In an article entitled “Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010” published August 25, 2014 in the Journal of the American Medical Association, researcher and primary author, Dr. Marcus A. Bachhuber, MD, with the Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, 423 Guardian Dr, 1303-A Blockley Hall, Philadelphia, PA 19104 (marcus.bachhuber@gmail.com), and others concluded that, “The present study provides evidence that medical cannabis laws are associated with

#ALpolitics could STILL $ave money if they were to #ExpandMedicaid

Alabama, among other states, should have expanded Medicaid when they had the opportunity to do so, and with SIGNIFICANT REWARD! In other words, at the very first. Now, if any state decides to expand Medicaid, there’s little, if any, incentive, except that there will be some savings to the state, and benefit to their citizens, by having access to healthcare.

A sick workforce can’t survive.

The Centers for Disease Control and Prevention (CDC) continually tell America that the sickest, the fattest, the most diabetic, the most smokers, and cancer-ridden, are in the Southeast… which largely voted for Trump, and has been predominately GOP-voting for at least the past 25+/- years. And I write of Alabama in particular.

In a November 2012 brief entitled “An Economic Evaluation of Medicaid Expansion In Alabama under the Affordable Care Act” by Professors Drs. David J.Becker, Ph.D.and Michael A. Morrisey, Ph.D of the University of Alabama at Birmingham School of Public Health, Lister Hill Center for Health Policy, they presented the case for the numerous potential benefits of expanding Medicaid in Alabama, which was not merely an improvement in the overall quality of life for Alabamians, but significant economic benefit to the entire state.

Drs. Morrisey and Becker are Professor and Director, and Assistant Professor, respectively, at the University of Alabama at Birmingham School of Public Health, Lister Hill Center for Health Policy, and have researched and written extensively the subject. The University of Alabama at Birmingham is one of three independent, autonomous universities in the UofA System.

Then-Governor Dr. Robert Bentley, MD, a Republican, was forced to resign in shame in the midst of his second term after pleading guilty to charges of corruption and ethics violations, and refused to expand Medicaid in “Sweet Home.”

The Bureau of Labor Statistics has most recently shown that employment in the Healthcare sector is thriving nationwide. The figures below are from the BLS’ most recent report “THE EMPLOYMENT SITUATION — MARCH 2018,” and is expressed in thousands. The columns in order, are: Not Seasonally Adjusted, March 2017, January, February, March 2018, and Seasonally Adjusted for the same times, respectively. (ESTABLISHMENT DATA Table B-1. Employees on nonfarm payrolls by industry sector and selected industry detail)

Drs. Morrisey and Becker identified that had then-Governor Bentley expanded Medicaid, a Federal/State program that pays healthcare costs for the impoverished, the state could have not merely eked it’s way out of recession, but it would have propelled itself in rocket-like fashion, to a position of economic strength and stamina.

They cited a provision in the Patient Protection and Affordable Care Act (ACA) which provided incentive to states to expand Medicaid by offering a one-time bonus of paying for 100% of all costs in 2014, followed by nominal reductions each year thereafter. And if states chose to expand Medicaid, they would have paid LESS (a smaller percentage) even after all incentives expired. Medicaid is a Federal-State sharing program in which the states bear a certain portion, while the Federal Government picks up the remaining share.

They wrote in part, that “Under the ACA, Alabama would receive a significantly higher Federal Matching Assistance Percentage (FMAP) for the expansion population than the 68.5% it currently receives for the non ‐ expansion population. The ACA provides for a uniform FMAP to all states of 100% in 2014 ‐ 2016, 95% in 2017, 94% in 2018, 93% in 2019 and 90% in all years thereafter.”

Presently, because Alabama has chosen to NOT expand Medicaid under the provisions of the ACA, they are STILL paying MORE for Medicaid than if they would have expanded it… even now, in 2018. That’s because the OLD law, under which the state labors, requires Alabama (and other states that did not expand Medicaid) to pay 31.5%. If Alabama would EXPAND Medicaid even now, in 2018, they would pay only 10%.

Governess Kay Ivey, also a Republican, who as Lt. Gov. assumed office following Bentley’s resignation after pleading guilty to corruption and ethics violation charges, has similarly expressed her reticence to expand Medicaid.

In 2016, Alabama spent $5,461,151,125 for Medicaid.

Noting that their “analysis does not consider potential savings from reduced spending on uncompensated care, mental health care and other services currently provided to the expansion population,” assuming the state expanded Medicaid and would pay “6.2% of program costs through 2020,” Drs. Morrisey and Becker projected three scenarios of a high, moderate, and low “take-up,” meaning enrollment into the program, and wrote that, “we estimate that the state of Alabama would be responsible for $771 million (6.2%) of the estimated $12.5 billion in new Medicaid program costs over the 2014 ‐ 2020 period,” and noted specifically, that “If more previously uninsured or privately insured individuals elect to enroll in Medicaid costs to the state and Federal government would rise. If take ‐ up were lower, the costs to the state and Federal government would fall.”

If Alabama had chosen to expand Medicaid in 2016 – the last year the Federal Government paid 100% of ALL COSTS of expansion – the state would have SAVED $5,461,151,125… the TOTAL cost of Medicaid. If Alabama were to expand Medicaid in 2018 (this year), they would pay only 6.2% of the costs, while the Federal Government would pay 93.8%. Using a high “take-up” scenario for 2018, Drs. Morrisey and Becker projected the state would pay $243,000,000… about 77.5% LESS than what it paid in 2016. A low “take-up” scenario for 2018 would be 46.48% lowered costs to the state.

The state has a peculiar and non-standard practice of having TWO budgets, the Education Trust Fund and General Fund budgets. Medicaid is paid from the General Fund budget, which is the smaller of the two, and receives “Taxes from over 40 sources are deposited into the GF, with the largest sources being the insurance company premium tax, interest on the Alabama Trust Fund and state deposits, oil and gas lease and production tax, cigarette tax, ad valorem tax, and Alabama Alcoholic Beverage Control Board profits,” and pays for and “supports state programs such as child development and protection, criminal justice, conservation efforts, economic development, public health and safety, mental health, Medicaid, legislative activities, and the court system.”

The much larger Education Trust Fund, receives revenue from “Ten tax sources are allocated to the ETF, the largest of which are the individual and corporate income tax, sales tax, utility tax, and use tax.” Revenues from the Education Trust Fund “support, maintenance and development of public education in Alabama, debt service and capital improvements relating to educational facilities, and other functions related to educating the state’s citizens. Programs and agencies supported by the ETF include K-12 education, public library services, performing and fine arts, various scholarship programs, the state’s education regulatory departments, and two- and four-year colleges and universities. Funding from the ETF is also provided to non-state agencies that provide educational services to the people of Alabama, including the arts, disease counseling and education, and youth development.”

Medicaid requires states to cover:
• Pregnant women up to at least 138% of the Federal Poverty Level (FPL) ($16,643 for an individual, $33,948 for a family of four in 2017)

• Preschool-age children up to at least 138% of the FPL ($16,643 for an individual, $33,948 for a family of four in 2017)

• School-age children up to at least 100% of the FPL ($12,060 for an individual, $24,600 for a family of four in 2017)

• Elderly and disabled individuals up to at least 75% of the FPL ($9,045 for an individual, $18,450 for a family of four in 2017)

• Working parents up to at least 28% of the FPL ($3,376 for an individual, $6,888 for a family of four in 2017)

Moreover, however, Alabama could have improved its economy by expanding Medicaid. In that same report, Drs. Morrisey and Becker considered three possible scenarios also based upon a high, moderate, and low “take-up” rate which showed that Alabama could have benefited between $2.331 billion and $33.529 billion in additional value added to the state’s economy from 2014-2020 (Low-to-High, inclusively and respectively).

They concluded that, using the intermediate, or moderate “take-up” scenario, “we project that a coverage expansion would reduce the state’s uninsured population by approximately 232,000 individuals while generating $20 billion in new economic activity and a $935 million increase in net state tax revenues.”

Again, that does NOT include the savings from eliminating uncompensated care.

Bottom line?

It would STILL be exceedingly wise for Alabama to expand Medicaid.

Why I Advocate 100% Marijuana Legalization

Let there be NO MISTAKE: Based upon a preponderance of scientific evidence, logic, reason, and numerous substantiating rationales, I openly advocate for, and am a proponent of the 100% full and total legalization of marijuana (aka cannabis) for adult recreational, and medical use.

And as a triple-degree, BSN-prepared Registered Nurse, Nationally Certified EMT, State Certified Volunteer Firefighter, and First Responder, I am a long-time Licensed Healthcare Professional, and presently possess, and have possessed unblemished active licenses to practice in numerous states, and internationally.

While I have “worn other hats” in Nursing, the bulk of my professional healthcare career has been in Critical Care. Working in Critical Care is the type of stressful job in which one keeps the Grim Reaper at bay by the hour. And I have been fortunate to have worked at some of the nation’s, and world’s premiere, and leading healthcare research institutions. It is research that drives much of such care, to ensure the best possible outcomes for the individuals for whom we care. Thus, keeping abreast of current research findings on many topics within, and without Critical Care, healthcare, and public policy related to healthcare in general, is a special interest and forté of mine.

As well, I am also a United States

National Academies #Marijuana Findings @theNASEM

Many have heard or read about United States Attorney General Jeff Sessions’ ignorant remark about marijuana, and many of us have heard or read numerous claims about cannabis, ranging from “it cures cancer” to “it makes you hungry,” and almost everything between. But if you want to make an effective argument for or against anything, you need facts. And the following information from the National Academies of Sciences, Engineering, and Medicine is THE MOST authoritative, up-to-date volume on the subject of cannabis. You would be wise to cite this research when you lobby your local, state or national legislator to legalize (or not) marijuana. (I am a legalization proponent & advocate for the 100% legalization, regulation, and taxation of adult recreational & prescriptive medical use of marijuana.)

Now, with the 2017 release of “The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research” by the Committee on the Health Effects of Marijuana: An Evidence Review and Research Agenda, Board on Population Health and Public Health Practice Health and Medicine Division, A Report of the National Academies of Science, we have one of THE MOST to-date conclusive pieces of EVIDENCE for/against cannabis consumption, either medically, and/or recreationally. It is AUTHORITATIVE, and unbiased. Bear in mind, this is findings of SCIENTIFIC MEDICAL RESEARCH.

An independent examination of the report was carried out in accordance with institutional procedures and all review comments were carefully considered. A committee of experts was convened to conduct a comprehensive review of the literature regarding the health effects of using cannabis and/or its constituents that had appeared since the publication of the 1999 IOM (Institute of Medicine) report.

From their review, the committee arrived at nearly 100 different research conclusions related to cannabis or cannabinoid use and health.

Committee members formulated four recommendations to address research gaps, improve research quality, improve surveillance capacity, and address research barriers.

Categories, including subtopics, are as follows:

Therapeutic effects
• Chronic pain; cancer, chemotherapy-induced nausea/vomiting; anorexia and weight loss; irritable bowel syndrome; epilepsy; spasticity related to multiple sclerosis or spinal cord injury; Tourette syndrome; amyotrophic lateral sclerosis; Huntington’s disease; Parkinson’s disease; dystonia; dementia; glaucoma; traumatic brain injury; addiction; anxiety; depression; sleep disorders; post-traumatic stress disorder; schizophrenia and other psychoses

Cancer
• Lung cancer; head and neck cancer; testicular cancer; esophageal cancer; other cancer

Cardiometabolic risk
• Acute myocardial infarction; stroke; metabolic dysregulation, metabolic syndrome, prediabetes, and diabetes mellitus

Respiratory disease
• Pulmonary function; chronic obstructive pulmonary disorder; respiratory symptoms (including chronic bronchitis); asthma

Immunity
• Immune function; infectious disease

Injury and death
• All-cause mortality; occupational injury; motor vehicle crash; overdose injury and death

Prenatal, perinatal, and postnatal exposure to cannabis
• Pregnancy complications for the mother; fetal growth and development; neonatal conditions; later outcomes for the infant

Psychosocial
• Cognition (learning, memory, attention, intelligence); academic achievement and educational outcomes; employment and income; social relation- ships and other social roles

Mental health
• Schizophrenia and other psychoses; bipolar disorders, depression; suicide; anxiety; post-traumatic stress disorder

Problem cannabis use
• Cannabis use disorder

Cannabis use and abuse of other substances
• Abuse of other substances

Weight Of Evidence Categories for Conclusions are ranked High-to-Low-and-None as Substantial, Moderate, Limited Evidence, and No or Insufficient Evidence to Support the Association for therapeutic effects, and other health effects.

Here are: 
Conclusions—Therapeutic Effects of Cannabis and Cannabinoids

There is conclusive or substantial evidence that cannabis or cannabinoids are effective:
• For

Members of Congress: Virtual American Royalty… At Taxpayer Expense

Members of Congress as virtual royalty,
have raised their pay 9 times over 9 years,
but raised Minimum Wage only 3 times in 18 years.
While Congress now pays themselves almost
3x the Median Household Income,
since 2000,
Inflation has totaled 37.4%.
And with 72% subsidies, Employer Contributions,
and other
luxurious perks unavailable to the Average Citizen,
including full Retirement Vestment after 5 years,
and 72% subsidy for Healthcare Insurance in Retirement,
their Healthcare is practically free.
And you’re paying for it.
But yours is not.
And you’re paying for it, too!

Members first received $6 a day in 1789, today they get $174,000 annually, in addition to phenomenal perks, health insurance, and retirement… all at taxpayer expense.

Presently, Congress also gets:

Why All Christians Should Support Abortion Rights

I support abortion rights for women. Here’s why.

Freedom, Liberty, and Independence.

And, I’m Catholic.

I have a cousin who

Charles Manson And Mental Health

“The murders were probably the most bizarre in the recorded annals of American crime. I’ve often said that if these murders had never happened and someone had written a novel, with the same set of facts and circumstances, you’d probably put it down after a couple of pages. Because to be good fiction, as I understand it — unless it’s science fiction — it’s got to be somewhat believable, and this is just too far out.”

– Vincent Bugliosi (1934-2015), Los Angeles County District Attorney, Chief Prosecutor in the Charles Manson trial, to NPR in 2009

Some years ago, during Mental Health Clinical Rotations, I was impressed with the insidious nature of severe mental health problems, which often masquerade as mere quirks, eccentricities, or peculiarities of character. In that sense, I think Southerners are more adept at denial of mental health problems than others in regions throughout the United States. We often laugh and joke about “Old Spinster Miss So-And-So,” “the Crazy Cat Lady,” or “Old Man Mozz” who for years has lived by himself.

And yet sometimes, we’re shocked at what we do NOT see, which when given opportunities to see “behind the scenes,” observation provides confirmation and undeniable proof-positive of mental health problems.

I recall in particular some time ago in which a friend and his wife had

How To Resolve Gun Sickness & Disease

Firearm fascination has gotten to the point of ridiculousness, to the extent that it’s much like a paraphilia. It’s no longer merely “disturbing,” its downright dangerous, and blatantly irresponsible. As Healthcare professionals, we research & examine the scope, extent, and exact nature of the problem, then make a diagnosis, and formulate a plan of treatment to either ameliorate the symptoms, or cure the disease. It presumes, of course, that the patient will cooperate with the plan, and follow the course of treatment.

In this present “gun nut” scenario in which we find ourselves suffering, the NRA has bent over backwards to

Here’s Why, Despite Seeming Political Appearances, We Are Closer To Single Payer #Healthcare Than Many Imagine

In a recent exchange online dialogue with friends – some, whom to the casual observer would be diametrically opposed on many policy ideas – I was, once again, pleased to note that, despite the SEEMING APPEARANCE of differences, we share SIGNIFICANT common ground.

In fact, I have found that to be quite true with many, that when we move past the vitriolic venomous sport of castigating political candidates, and speak in respectful tones, patiently explaining the whys and wherefores of potential policy, we share many common bonds, and similar ideas.

For example, in response to a recent post of the story published by Pro Publica – Pressure Mounts on Insurance Companies to Consider Their Role in Opioid Epidemic – (https://www.propublica.org/article/pressure-mounts-on-insurance-companies-to-consider-their-role-in-opioid-epidemic) written by Charles Ornstein Oct. 19, 6:47 p.m. EDT – I enjoyed reading the following remarks, made toward the conclusion of the online dialogue:

Person A (Physician): “It is a shame our country can’t have

Helping Comes First

 When Saint Pius of Pietrelcina (1887-1968) — Padre Pio as he’s widely known — decided he wanted to build a free hospital for the poor up the road from his friary, he started with a piece of land and a few friends and supporters. Four years later, in 1956, he had one of the most modern hospitals in Europe. Since the padre’s death in 1968, the facility, which

Can American Health Insurance Be Repaired?

Naysayers to the “public option,” or “single payer” health insurance plan claim that it’s “socialized medicine.” You know… much like what Military Service Members  – and their families – in the Army, Air Force, Navy and Marines have access to. And to be certain, the health insurance “money grab” came through Richard Nixon‘s signature on a bill written by  Massachusetts’ U.S. Senator Edward Kennedy… the Health Maintenance Organization Act of 1973.

Before that law was passed, it was ILLEGAL to profit from delivery of healthcare services. Now, we have avariciously rapacious Wall-Street masters slave driving the people for more and more and more and more profit. The greedy, never-ending quest for profits has quickly deteriorated the American healthcare delivery system, which was once a marvel of the world. Now, according to the World Health Organization 2000 report of its 191 member nations health systems, the United States ranked 37th in efficiency worldwide, while France, Italy, San Marino, Andorra, and Malta round out the top five most efficient nations for delivery of healthcare services. Japan ranks 10th, while the United Kingdom is 18th, and Canada is 30th. The United States is sandwiched in between Costa Rica, and Slovenia, respectively.

Truth be told – and it’s sad to say – there are probably as many corrupt Democrats as there are corrupt Republicans, neither of whom have the people’s best interests at heart, or in mind. Such ones’ solitary concern is with their own wallet, and how they can profit privately at taxpayer expense. That includes graft through directing contracts and business toward friends’ business interests.

Look at

Advice For Lovers Everywhere

Have you ever, in a passionate moment, had your ear gently kissed by the lips of your lover? The sensation of tenderly soft and warm skin brushed up against the lobe of your ear, or even a light flicker of the tip of the tongue anywhere on the ear is to many, sensuously delightful, and highly erotic.

For some, it’s enough to send shivers down your spine! Your entire body quivers with passionate delight!

Of course, such a moment is nothing like