Remember: TAKE OUT THE TRASH IN NOVEMBER!

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

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

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

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

 

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

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

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

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

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

How Can I Keep From Getting COVID-19 ?

Preventing COVID-19 Infection

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Now, let’s move along toward treatment.

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

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

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

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

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

But, imagine if, in response to

Questions & Answers About Cannabis

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

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Updated Friday, 18 September 2020

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

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

So in that sense, enjoy!

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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.

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QUESTION: Does CBD modulate 5-HT1A receptor activity?

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

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

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

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

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

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

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

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QUESTION: Does the CBD molecule contain an aromatic ring?

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

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QUESTION: Describe the chemical makeup of endocannabinoids.

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

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

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

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

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

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

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

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

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

—

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

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

—

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

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

—

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

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

—

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

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

—

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

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

—

QUESTION: Does ketamine interact with the endocannabinoid system?

ANSWER: Yes. Ketamine induces the release of endocannabinoids.

—

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

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

—

QUESTION: Do opioid antagonists impact the effects of cannabinoids?

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

—

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

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

—

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

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

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

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

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

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

—

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,

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

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

Want More #Sex? Smoke More #Cannabis!

NPR recently reported about research that seems to point to one benefit of daily use of cannabis.

Increased sexual activity.

I continue to maintain that:
a.) People NEED & OUGHT to have MORE SEX, and;
b.) Cannabis NEEDS & OUGHT to be legalized, taxed & regulated.

Because:
a.) No one ever had an orgasm while “mad” or “angry,” and;
b.) I’ve neither read nor heard of anyone being “mad” or “angry” while high.

Fact is, research is continuing to show that increasingly, people are ANGRY at/because of many things, some of which are outside the locus of their immediate control, and that correspondingly, people are having sexual encounters less often – including married couples (for the benefit of those who believe that sexual activity belongs only among married couples). STOP ANGER! Get high! Have sex!

There’s SIGNIFICANTLY MORE argument to be made AGAINST ETOH (ethanol alcohol, aka “beverage” alcohol) than against cannabis.

Researchers Find Frequency of Sex Rises With Marijuana Use

“Surveys of 50,000 people found that those who smoked marijuana had sex more often than those who

Q: How is #ALpolitics similar to Portland, OR?

Portland, Oregon and Birmingham, Alabama couldn’t be further apart in many ways – geographically, and politically, particularly. However, recent research show that one attitude in particular is very similar.

And that is, resident’s thoughts about

Keep Your Horse And Your Heart Healthy: A How To Guide

In the late-1970s, a pioneering medication was discovered in Japan which was made from a single microorganism.

Isolated at the Kitasato Intitute, Tokyo, Japan, it came from a single Japanese soil sample, and has had an immeasurably beneficial impact in improving the lives and welfare of billions of people worldwide. And, despite continued research since, it has only been found in Japan.

While it was originally introduced as a veterinary medication and found to kill a phenomenally wide range of internal and external parasites in livestock and companion animals, it was quickly discovered to be ideal in combating two of the world’s most devastating and disfiguring diseases which have plagued the world’s poor throughout tropical regions for centuries. It’s now being used free-of-charge as the exclusive tool in campaigns to eliminate both diseases globally, and has also been used to successfully overcome several other human diseases, with new uses for it continually being found.

Few medications can seriously lay claim to the title of ‘Wonder Drug’, and penicillin and aspirin are two that have perhaps had the greatest beneficial effect on the health and well-being of Humankind. But this medication can also be considered alongside those worthy contenders, based on its versatility, safety and the beneficial impact that it has had, and continues to have, worldwide — especially on hundreds of millions of the world’s poorest people.

The medication treats

Government–Mandated Waste Drives Up Prescription Drug Co$t$

 

Just Like Food “Expiration” Dates, Drug “Expiration” Dates Are Also Fake… And It’s Co$ting You BIGTIME

Hospitals and pharmacies are required to toss expired drugs, no matter how expensive or vital. Meanwhile the FDA has long known that many remain safe and potent for years longer.

The box of prescription drugs had been forgotten in a back closet of a retail pharmacy for so long that some of the pills predated the 1969 moon landing. Most were 30 to 40 years past their expiration dates – possibly toxic, probably worthless.
But to Lee Cantrell, who helps run the California Poison Control System, the cache was an opportunity to answer an enduring question about the actual shelf life of drugs: Could these drugs from the bell-bottom era still be potent?

Cantrell called Roy Gerona, a University of California, San Francisco, researcher who specializes in analyzing chemicals. Gerona had grown up in the Philippines, and had seen people recover from sickness by taking expired drugs with no apparent ill effects.

“This was very cool,” Gerona says. “Who gets the chance of analyzing drugs that have been in storage for more than 30 years?”

Pharmacist and Toxicologist Lee Cantrell tested medicines that had been “expired” for decades. Most of them were still potent enough to be on shelves today. (Lee Huffaker for ProPublica)

The age of the drugs might have been bizarre, but the question the researchers wanted to answer wasn’t.

Pharmacies across the country in major medical centers and in neighborhood strip malls routinely toss out tons of scarce and potentially valuable prescription drugs when they hit their expiration dates.

Gerona and Cantrell, a pharmacist and toxicologist, knew that the term “expiration date” was a misnomer. The dates on drug labels are simply

Your Child May Not Truly Be Allergic To Penicillin

Reported penicillin allergies in children usually inconsistent with true allergy

Jul 3, 2017

Clinical Essentials from Pediatrics

Takeaway
• Parent-reported penicillin allergy symptoms in children presenting to the emergency department (ED) are likely inconsistent with true, immunoglobulin E-mediated allergy when evaluated by the 3-tier penicillin allergy questionnaire.

• Data demonstrate that the true incidence of penicillin allergy is 0.004%-0.015%.

Why this matters
• Because of time constraints and invasiveness associated with standard allergy testing, an allergy pediatric questionnaire may optimize first-line penicillin use in children presenting with the ED with parent-reported penicillin allergies.

• Data suggest that the majority of reported pediatric penicillin allergy symptoms (eg, maculopapular rash, hives, vomiting, diarrhea) are actually low risk for true allergy.

Study design
• This study evaluated 597 children between the ages of

Are you over 65 & taking statin meds? Know anyone who is? It may not be worth it.

If you’re a prescriber, consider this research. If you’re a patient, or know someone who is, consider this for your, or their well-being.

—//—

Statins Have No Primary CVD Prevention Benefit To Older Patients

Takeaway
Statins offer no benefit for the primary prevention of cardiovascular disease (CVD) in adult patients aged ≥65 y.

Why this matters
“[S]tatins may be producing untoward effects in the function or health of older adults that could offset any possible cardiovascular benefit,” say the study authors.

Study design
Researchers conducted post hoc secondary data analyses of patient data from a randomized, open-label clinical trial (N=2867; age, ≥65 y; 49.4% women; all without evidence of atherosclerotic cardiovascular disease); patients were assigned to either a treatment group receiving pravastatin sodium 40 mg/d or a usual care (UC) group.
Funding: National Heart, Lung, and Blood Institute; AstraZeneca; Bristol-Myers Squibb; Pfizer; National Center for Advancing Translational Sciences; The Stroke Foundation.

Key results
Hazard ratios for all-cause mortality in the treatment group vs the UC group were

Rethinking Addiction

Perhaps you’ve studied the 12-Step program, or perhaps you’ve practiced it. I have done both. Practicing it was not as a matter of addiction, or any such thing for myself, but instead, was a part of my personal spiritual growth and development.

Over the years, I’ve heard commentary, or news features which interviewed people with divergent perspectives on 12-Step programs, most notably which were skeptical of them, and were thoughtfully seeking answers themselves for the “whys and wherefores” of substance abuse, whether it’s long-term or temporary, and whether it is a genetic fault, or if it is a personality or character flaw in response to external or internal stressors. In other words, it’s the classic “Heredity vs Environment” argument.

As I have come to view it, there is validity for both sides, but I think the stronger case is made for a combination of environment and character flaw, instead of genetic defect.

—/—

“In his recent book, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry, Lance Dodes, a retired psychiatry professor from Harvard Medical School, looked at Alcoholics Anonymous’s retention rates along with studies on sobriety and rates of active involvement (attending meetings regularly and working the program) among AA members. Based on these data, he put AA’s actual success rate somewhere between 5 and 8 percent. That is just a rough estimate, but it’s the most precise one I’ve been able to find.”

https://www.theatlantic.com/magazine/archive/2015/04/the-irrationality-of-alcoholics-anonymous/386255/

The Irrationality of Alcoholics Anonymous
By Gabrielle Glaser, April 2015 Issue
Its faith-based 12-step program dominates treatment in the United States. But researchers have debunked central tenets of AA doctrine and found

End ObamaCare’s Health Insurance Monopoly

Fact is, “ObamaCare” – which is properly known as the Patient Protection and Affordable Care Act, or ACA for short – though it’s monikered with POTUS Obama’s name, was largely a Republican brainchild from the über-conservative Heritage Institution.

The cornerstone of the act is predicated upon two items which are the very heart of the act: 1.) Guaranteed Coverage, and; 2.) Community Rating.

In was, in essence

How And Why Insurance Companies Control Your Medical Care

Some have accurately, and justifiably observed that the Affordable Care Act, also colloquially known as “ObamaCare,” is a big fat, sloppy wet kiss to the Big Insurance industry and their for-profit, Wall $treet corporate masters, because their profits have continued to soar since it’s inception. Note that UnitedHealth Group reported a profit of $11 billion (on revenues of more than $157 billion) in 2015, up from $10.3 billion (on revenues of $131 billion) in 2014. Consider also how Anthem’s business changed in just one recent year. At the end of 2014, the majority of Anthem’s revenues still came from its Commercial Health Insurance customers. During 2015, however, revenues from their commercial operations actually declined 4.2%, to $37.6 billion, while revenues from their government operations skyrocketed 21%, to $40.1 billion. A significant reason why, is because of the big investments Insurance Companies continue to make in House and Senate campaigns. As a result, the Insurance Industry’s tentacles will likely only get deeper into both the Medicare and Medicaid programs.

Medical equipment is pictured on the wall of an examination room inside a Kaiser Permanente health clinic located inside a Target retail department store in San Diego, California November 17, 2014. Four clinics are scheduled to open to provide pediatric and adolescent care, well-woman care, family planning, and management of chronic conditions like diabetes and high blood pressure for Kaiser members and non-members. REUTERS/Mike Blake (UNITED STATES – Tags: HEALTH BUSINESS SOCIETY) Fair Use

by Christy Ford Chapin

It’s that time of year again. Insurance companies that participate in the Affordable Care Act’s state health exchanges are signaling that prices will rise dramatically this fall.

And if insurance costs aren’t enough of a crisis, researchers are highlighting deficiencies in health care quality, such as unnecessary tests and procedures that cause patient harm, medical errors bred by disjointed or fragmented care and disparities in service distribution.

While critics emphasize the ACA’s shortcomings, cost and quality issues have long plagued the U.S. health care system. As my research demonstrates, we have these problems because insurance companies are at the center of the system, where they both finance and manage medical care.

If this system is so flawed, how did we get stuck with it in the first place?

Answer: Organized physicians.

As I explain in my book, “Ensuring America’s Health: The Public Creation of the Corporate Health Care System,” from the 1930s through the 1960s, the American Medical Association, the foremost professional organization for physicians, played a leading role in implementing the insurance company model.

What existed before health insurance companies?

Between the 1900s and the 1940s, patients flocked to what were called “prepaid physician groups,” or “prepaid doctor groups.”

Prepaid groups offered inexpensive health care because

.@PastorAmyTRC: I Had A Late Term #Abortion and “I never had a second thought about the right thing to do.”

Church Pastor: The Truth About My Late-Term Abortion

by Amy Butler, October 26, 2016, 7:55PM EDT

“Trump’s words drove me to tears, and to write my painful story for the first time.”

Elections are supposed to be about real people — and not the ones whose names appear on the ballot. They are supposed to be about all of us, the policies that will impact our lives in tangible ways and the choices we make about the country we want to be.

The Rev. Dr. Amy Butler is the Senior Minister of The Riverside Church in New York City. Prior to this call, Pastor Amy served as Senior Pastor of Calvary Baptist Church in Washington, D.C. Pastor Amy holds degrees from Baylor University (BA ‘91, MA ‘96); The International Baptist Theological Seminary (BDiv ‘95); and Wesley Theological Seminary (DMin ‘09).

But this year, we have watched a major candidate for our country’s highest office demean and slander whole categories of American citizens. We have watched him make offensive, outrageous claims about real people and real decisions that everyday Americans face. People like me. Decisions like mine.

What sent me to my computer to write is late-term abortion. As I heard Donald Trump talk about babies being “ripped” from their mothers’ wombs, as if ending a pregnancy is a reckless, irresponsible afterthought, my outrage poured down my face in angry tears. In those moments, Trump, who has never been pregnant and presumably has navigated this far in his life without undertaking any difficult, gut-wrenching, gray-area decisions, used my own pain — deep, deep pain — to advance his political agenda.

But his words won’t tell my story, so I’ll tell it here. I don’t often speak about this experience. And I’ve never written about it until now.

The late-term abortion I chose was the end of a dream. The pain was so real and so consuming that navigating my way through the grief, I never thought that I would have the happy, healthy family that I do today. It was one of the most agonizing experiences of my life and

Late Term #Abortion #Politics On #DebateNight

A few thoughts on a Presidential Debate topic by Moderator Chris Wallace of Fox News, with candidates Hillary Clinton (D) and Donald Trump (R) from the third, and final debate held last night at the University of Nevada, Las Vegas, Wednesday, 19 October 2016:

1.) Tweet from Dr. Jen Gunter, MD: “There is no such thing as a ninth month abortion – I’m a doctor who trained in late term abortions”
https://twitter.com/DrJenGunter/status/788912646330257408

2.) A portion of her blog entry (linked herein) on the topic from the Debate states: “Trump’s statement, as incorrect as it may be, supports the fallacy of the due-date abortion. It is a common anti-choice narrative that

How prevalent is psychiatric disorder following natural disasters?

What implications does this have for survivors of Hurricane Katrina, California Wildfires, Earthquakes, the September 11, 2001 Terrorist Attack on the World Trade Center, or any other disaster?

—

Psychiatric Disorders And Suicidal Tendencies In Survivors Of Natural Calamities

The Lancet Psychiatry
September 10, 2015

Survivors Of Natural Calamities Require Early Interventions To Alleviate Psychiatric Disorders

Background
Survivors of natural disasters are thought to be at an increased risk of psychiatric disorders, however the extent of this risk, and whether it is linked to pre-existing psychopathology, is not known. We aimed to establish whether Swedish survivors of tsunamis from the 2004 Sumatra–Andaman earthquake had increased risks of psychiatric disorders and suicide attempts 5 years after repatriation.

Methods
We identified Swedish survivors repatriated from southeast Asia (8762 adults and 3742 children) and 864 088 unexposed adults and 320 828 unexposed children matched for

Research: #Exercise Significantly Improves Anti-#Depression Therapy

For those whom are searching for adjunct, supplemental, or alternative therepeutic milieus, scientists and researchers have made some wonderful discoveries, and share the findings before the release of their research paper!

—

Randomized controlled trial of physical exercise as augmentation to antidepressant therapy for late-life major depression in primary care

August 4, 2015

Summary
Progressive physical exercise plus sertraline anti-depressant therapy achieves higher rates of depression remission than non-progressive therapy plus sertraline, or sertraline alone in primary care patients with late-life major depression.

Study Design
121 primary care patients were randomized to

Study: Cannabis Legalization Does Not Increase Underage Use

Consumption Of Marijuana With Respect To The Passage Of Respective State Medical Marijuana Laws

The Lancet Psychiatry – Jul 20, 2015

    The Passage Of Medical Marijuana Laws Could Improvise Medical Usage Of Marijuana, With Due Investigation

 

Background

 Adolescent use of marijuana is associated with adverse later effects, so the identification of factors underlying adolescent use is of substantial public health importance. The relationship between US state laws that permit marijuana for medical purposes and adolescent marijuana use has been controversial. Such laws could convey a message about marijuana acceptability that increases its use soon after passage, even if implementation is delayed or the law narrowly restricts its use. We used 24 years of national data from the USA to examine the relationship between state medical marijuana laws and adolescent use of marijuana.

Methods

Using a multistage, random-sampling design with

Sodomy: A prime example of what’s wrong with #ALpolitics

A dear friend who is a long-time retiree, aged 78 years, entire subsistence is from a meager pension (earned from a lifetime of work in a unionized organization), supplemented with a paltry Social Security check.

She’s lived through breast cancer surgery (mastectomy) & reconstruction, other major surgeries (knee replacements) and procedures, and lives in a trailer which she owns, situated upon a lot which she rents. She has resided there many, many years.

To save money, she recently

Alabama State Senator Larry Stutts sued for malpractice… again

Alabama State Senator Larry Stutts has once again been named in another malpractice lawsuit in which a patient of his retained placental tissue, and suffered excessive bleeding following delivery of her baby.

The new case is oddly reminiscent of an older case in which Stutts was named defendant, in which his patient retained placental tissue and suffered excessive bleeding, and later died. The new case’s Plaintiff, Greta C. Cooper, did not die.

Read the PDF file of the 2015 Lawsuit against state Sen Larry Stutts

The suit alleges, among other things, that Stutts failed to order powerful antibiotics to be administered EXCLUSIVELY by Licensed Professional Nurses, and that two RNs with Gentiva Home Health Services in Russellville, Alabama, then taught the Plaintiff’s husband how to administer the medication, and that as a result of his failure to properly order, blood levels of the medication were also not taken which resulted in overdose toxicity.

Dr. Larry Stutts, DVM, MD (R), who was first a veterinarian, then became an Obstetrician/Gynecologist (OBGYN), upset 32-year veteran Alabama Senate District 6 State Senator Roger Bedford (D) by 67 votes in the 2014 November General Election. Stutts is also president of Colbert Obstetrics and Gynecology, PC (his private medical practice), located at 1120 S Jackson Hwy #104, Sheffield, AL 35660, (256) 386-0855.

Alabama District 6 State Senator Dr. Larry Stutts, DVM, MD

Alabama State Senate District 6 encompasses all of Franklin County, and portions of Colbert, Marion, Lauderdale and Lawrence Counties in NW Alabama.

Interestingly, Sutts wasn’t the GOP’s original candidate for the Senate District 6 race. Jerry Mays was the original GOP candidate, but dropped out of the primary. In response to Mays’ decision, on March 20, 2014, State Republican Party Chairman Bill Armistead announced that the Alabama Republican Party Candidate Committee had met and named Larry Stutts, who resides in Tuscumbia, to replace Mays candidacy. Stutts had never been in any elected political office.

Stutts is the same physician who was years earlier named in another lawsuit in which his patient Rose Church – a newlywed, and healthy 36-year-old Registered Nurse – died, which in turn,

Medical News You Can Use: “I hate you; you’re stupid” Edition – Brain Stimulation Reduces Racial Prejudice

Brain Stimulation Reduces Racial Prejudice

Racial discrimination remains to be a pressing issue across the globe. In a study published in “Brain Stimulation“, Dutch researchers have now demonstrated that racial prejudice can be reduced with brain stimulation.

Scientists at the University of Leiden, Leiden, Netherlands, conducted an experiment in 60 healthy volunteers. Half of the group received transcranial direct current stimulation (tDCS) with a low intensity current administered by electrodes placed on the frontal part of the scalp. The other half received sham treatment.

During the treatment, the participants were

Is God an Abortionist?

The Bible never mentions abortion.

It doesn’t suggest it, nor does it even hint at it.

The Bible doesn’t forbid prostitution.

In fact, there are many things the Bible doesn’t even mention.

But it does forbid eating pork, shrimp, oysters, mussels, clams, cheeseburgers, wearing clothing made with cotton/polyester blended  fabric, that a man should marry his brother’s wife if the brother dies before impregnating her, and several hundred other nonsensical rules, regulations and laws – almost all of which were religiously based upon ignorance.

At the time the Bible was written (approximately 4000 BC/BCE), there was no understanding of Germ Theory (1864). No one understood Bernoulli’s Principle (1783). In fact Bernoulli wasn’t even born then. No one understood the physics and principles of lift, low pressure, high pressure, or how weather systems occurred. Even the beer and wine that was made then was thought to have been made magically – as if it were some kind of mystical gift from the gods, a god, or the God. They had no idea – were literally clueless – that it was through fermentation, because

Medical News You Can Use: “Dr. Atkins Was Right” Edition – Carbs Make You Fat, Not Just Inactivity

Researchers: Diet To Blame For Obesity, Not Lack Of Physical Activity

Lack of physical activity is not to blame for the prevalence of obesity, but rather the wrong diet, report physicians from the United States, United Kingdom, and South Africa who published their findings in the “British Journal of Sports Medicine.” However, they emphasized that even regular exercise cannot compensate for poor dietary habits.

Excess consumption of sugar and carbohydrates is mainly responsible for obesity, say the experts. Even 40% of people with a normal BMI will consequently have metabolic abnormalities normally associated with obesity.

But it is problematic that the public firmly believes that development is exclusively due to lack of physical activity. That misconception is due almost exclusively to

Medical News You Can Use: Sleep Apnea Can Harm Children’s Learning

Disruption Of Sleep In Children Could Hamper Memory Processes

Sleep disordered breathing can hamper memory processes in children, according to a new study presented at the Sleep and Breathing Conference held in April in Barcelona, Spain. The research found that disrupted sleep had a negative effect upon different memory processes and how children learn.

Sleep apnea can also negatively affect growing children.

A team of researchers from the University of Szeged and Eötvös Loránd University in Hungary analyzed 17 children with sleep disordered breathing aged between 6 and 12 years. They looked at different memory processes compared to a control group of 17 children of similar age without any sleep disorders.

A story recall task was used to measure memories that can

Medical News You Can Use: “Can I Please Get Some SLEEP!?!” Edition – Children’s Hospitals Lack Standards

As anyone who has been in a hospital – either as patient, or visitor – can attest, hospitals are NOT a place where rest occurs. And THAT! is a crying shame! For healing restoration can ONLY occur with proper rest, and that means SLEEP!

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Study Reveals An Absence Of Consistent Standards In Children’s Hospital Environments

The sound, light and temperature levels in European pediatric hospital wards often vary, highlighting the lack of consistent environmental standards, according to a new study presented at the Sleep and Breathing Conference held in April in Barcelona, Spain.

Quietude aids healing and restoration

Children and parents often suffer sleep deprivation when the environment on a ward is disruptive, which can affect disease recovery and quality of life in hospitalized children. There are no general consistent recommendations covering sound, light, and temperature levels to help guide hospitals across Europe.

Researchers measured these three factors in five pediatric wards in

Medical News You Can Use: “Musician’s Friend” Edition – Wind Instruments Lower Sleep Apnea

Playing A Wind Instrument Could Help Lower The Risk Of Sleep Apnea

A study performed in India suggests wind instrument musicians are at lower risk for Sleep Apnea. Seen here, a B-flat trumpet.

A new study has found that wind instrument players have a reduced risk of developing obstructive sleep apnea. The findings, presented at the Sleep and Breathing Conference held in April in Barcelona, Spain suggest that this could be considered beneficial to those individuals who are at high risk of developing sleep apnea.

Researchers in India conducted lung function testing in

Medical News You Can Use: Statins Increase Diabetes In White Males

Statins Increase Risk Of Type 2 Diabetes By 46%

Taking statins significantly increases the likelihood of developing type 2 diabetes. According to a Finnish study published in “Diabetologia,” the risk is 46% higher.

In their study, researchers from the University of Eastern Finland and Kuopio University Hospital included 8,850 men aged from 45 to 73, who had not been diagnosed with diabetes at the beginning of the study. During the observational period of almost six years,

Medical News You Can Use: Household Animals Can Pass Along Diseases

Household Animals Can Pass Along Diseases

While there are many positive effects of keeping household pets, they can also pass along diseases. In a study published in the “Canadian Medical Association Journal,” Canadian and American researchers warned that animals are able to transmit numerous pathogens to their owners.

Scientists from The Ohio State University in Columbus, and the University of Ottawa in Ontario performed a meta-analysis of existing literature, which mainly included reports on individual cases but contained no systematic studies.

For healthy people, the risk of contracting a disease was low if the animals were adequately kept and hygiene guidelines followed. However, children younger than 5, adults older than 65, people who are ill, and pregnant women were at increased risk of developing a zoonotic disease. Moreover, researchers found in that group of people the diseases may be more severe, symptoms may last longer, and the risk of complications was higher.

Practically all household pets can transmit pathogens. Transmission occurs through bites and scratches, contact with feces, when cleaning cages, or when an animal licks a person.

Dogs and cats can transmit the diarrhea pathogen Campylobacter jejuni, and cats also pass on Bartonella bacteria. Infection with resistant bacteria such as ESBL, MRSA or Clostridium difficile, is possible between humans and animals in both directions.

Parasites, such as worms, are usually contracted from dogs and cats. Cats can also pass on the bacteria Toxoplasma gondii, which can lead to serious birth defects in unborn children, or even miscarriage. Amphibians and reptiles commonly transmit salmonella. According to U.S. studies, about 11% of all salmonella infections in those under age 21 are caused through contact with those animals.

In general however, the companionship provided by household pets has more positive than negative effects. Dogs, in particular, contribute to protecting toddlers against allergies and respiratory infections. Furthermore, canines have positive effects on the psyche and especially have positive effects because owners get more exercise by taking the animal out.

Medical News You Can Use: The “Pour Some Sugar On Me!” Edition

Maple Syrup May Make Bacteria More Susceptible To Antibiotics

According to Canadian researchers, maple syrup may have the potential to make bacteria more susceptible to antibiotics, thus leading to lower usage of the medicines. That is the finding of a study recently published in “Applied and Environmental Microbiology.” The syrup extract also contributed towards destroying biofilms.

Using common maple syrup, researchers at McGill University in Montreal produced an extract

Open Letter to Alabama Governor Robert Bentley, MD

Open Letter to Governor Bentley
October 10, 2014 at 12:45pm

Governor Bentley,

I need to go to the doctor. But I can’t. For some reason I still can’t understand you turned down Federal money set aside for people like me.

On June 24, 2014, on my way to see a doctor to determine disability benefits, I had a car accident. My car was totaled and my lip busted. I had hit the steering wheel with my face.

I still almost refused the ambulance ride because I was afraid of the bill. It took a street full of people to convince me to go. I had my lip sewn up, some scans done. I was sent home with a neck brace.

I have $12,000 in bills now, and my disability was denied. I am more disabled now than before the accident. I am waiting on an appeal with no medical care and no income. That hospital bill will never get paid. I wonder how many other people in this state are in the same situation. Sometimes I think

The Future of Computing, the Internet & Healthcare

“Mature” applications’ resurrection will hinge upon touch-screen technology which will further cement the GUI as a future power broker, and external scripts -which presently have numerous problems inherent to their own shortcomings- will become inherently integrated within the framework of an OS while HTML will morph into a similarly integrative & secure distributive computing platform (P2P), which proof of concept has been demonstrated by BitTorrent & Tor.

Should a “Mental Health Tax” be placed on Marijuana?

Let’s talk about drug abuse.

Abuse of any kind is improper use, or dependency. In some cases, so-called “recreational” use is “abuse,” for there is no other kind of use, since a drug may be already illegal.

For the greatest part, those drugs, which are sometimes mistakenly called ‘narcotics’ (technically, narcotics are derivatives of and synthetic chemical relatives to the opium plant) are already illegal, and include LSD and other hallucinogens, heroin, methamphetamine (as “crystal meth”), etc. And, at the Federal level, like it, or not, agree or disagree, marijuana is included in that list.

Further, alcohol must be included in the list of abused substances, simply because we know that people’s lives can be, and are destroyed by alcohol abuse, directly and indirectly.

There’s a database of information based upon hospital admissions related to drug abuse. It’s called the Treatment Episode Data Set, or TEDS, and the information is collected anonymously by each facility in a state that receives “State alcohol and/or drug agency funds (including Federal Block Grant funds) for the provision of substance abuse treatment.”

It is not an exhaustive data set by any means, and there are limitations upon it, yet it does provide some reliable degree of accuracy to the extent, scope and nature of the problem. Consequently, information in “the tables focus on treatment admissions for substance abusers.”

In other words, someone abuses a substance on the list to the extent that they need some degree of care, including hospitalization, and that anonymous information about their admission gets collected and reported. For the purposes of that report, anonymous information is age, sex, ethnicity/race and drug(s) which led to the need for treatment.

The TEDS list of abused drugs are:

How Honest is Your Doctor?

If you had an option, would you rather pay $10/month, or $80/month for a prescription medication that accomplished/did the exact same thing?

Research shows that the results of the 2 differently priced medicines have never been shown to be any better in any way.

Which would you choose?

Why?

What if your doctor prescribed the more expensive medication for you based on the fact that

Psychiatric Madmen? New manual makes everyone mentally sick.

Perhaps an alternate title for this would be “We’re in it for the money.”

See also another related entry entitled “Mental Health Profession has Mental Health problems.”
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“We’re all mad here”

Medication misuse is out of control in the US and more psychiatric labelling in DSM-5 will not help.

by Allen Frances | Tuesday, 21 May 2013

That’s the message of the new edition of the bible for American psychiatrists, DSM-5. Diagnostic inflation is about to become hyperinflation.

“We are all mad here” explains the Cat to Alice when she wonders about the strangeness of Wonderland. Well, life is starting to follow art. If people make the mistake of following DSM-5, the new diagnostic manual in psychiatry that was published on Saturday, pretty soon all of us may be labelled mad.

When I worked on the taskforce for DSM-4, we were very concerned about taming diagnostic inflation – but we only partly succeeded. Then four years ago, I became aware of the excessive enthusiasm around all the new diagnoses being proposed for DSM-5, including many that were untested. I hate to rain on anyone’s parade, but I knew this would be disastrous for the millions of people who were likely to be mislabelled, stigmatised and given excessive treatment.

In the US, the “sick” are distinguished from the “well” by the diagnostic and statistical manuals developed by the American Psychiatric Association.

The problem is that definitions of mental disorders are already written too loosely and are applied much too carelessly by clinicians, especially by the GPs who do most of the prescribing of psychiatric drugs.

And things are about to get much worse. Under DSM-5 diagnostic inflation looks set to become hyperinflation and will lead to an even greater glut of unnecessary medication. I would qualify for a bunch of the new labels myself – and you might too.

The grief I felt when my wife died would now be called “major depressive disorder”; forgetfulness in older age “mild neurocognitive disorder”; my gluttony now “binge eating disorder”; and my hyperactivity “attention deficit disorder”. As for my twin grandsons’ temper tantrums, this could be misunderstood as “disruptive mood dysregulation disorder”. And if you have cancer and your doctor thinks you are too worried about it, there’s “somatic symptom disorder.” It goes on, but you get the idea.

About half of Americans already qualify for a mental disorder at some point in their lives and the rates keep skyrocketing, especially among kids. In the past 20 years, the prevalence of autism has increased, childhood bipolar has multiplied 40-fold and attention deficit disorder has tripled.

One consolation: the kids are not suddenly getting much sicker – human nature is pretty stable. But the way we label symptoms follows fickle fashions, changing quickly and arbitrarily. And freely giving out inaccurate diagnoses can

NYC Seeks to Curb Painkiller Abuse With Hospital Limits

It’s only “deadly” if it’s misused or abused.

And yet, the idea is an excellent one because it limits potential for misuse and abuse by fraud.

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New York City is seeking to curb abuse of potentially addictive and deadly painkillers such as Oxycontin and Vicodin with new limits on how widely the drugs should be prescribed.

Emergency departments at New York’s public hospitals will only prescribe a three-day supply of opioid painkillers, won’t refill lost or stolen prescriptions and shouldn’t prescribe long-acting versions of the drugs, according to voluntary guidelines the city issued today.

The move is aimed at

Fit for Human Consumption, or Rat Poison? High Fructose Corn Syrup Continually Indicted in Obesity Epidemic.

Fit for Human Consumption, or Rat Poison? How many foods use High Fructose Corn Syrup? The answer might surprise you. Or, it may not. Originally uploaded by SouthernBreeze

In the last several years, obesity has become a rampant epidemic in the United States. While there are doubtless many causes, it is my opinion that a wholesale change in our dietary practices – and I specifically do not mean to refer to increased portion sizes, consumption or intake – but rather to an ingredient which has become all too common in commercially prepared food… which, if we were honest with ourselves, is most of what we consume.

For example, the majority of Americans do NOT grow their own vegetables, raise their own groceries (meat, dairy, poultry, eggs, pork, etc.), nor do they eat homegrown, locally grown, or even “freshly prepared” vegetables, even if those vegetables were imported to the United States. Consider even pineapples, for example. Once, the exceeding majority of the world’s supply of pineapples were grown in Hawaii. The highest quality pineapples are sold to Japanese markets, where they pay top price for the highest quality fruit. Not so in the United States, where American customers balk at high prices, even if it’s associated with higher quality.

Historically, Hawaii was the world’s largest pineapple producer and source for pineapples. Relatively recently however, rapacious corporate profit seekers abandoned Hawaii for cheaper production (translate “cheap labor” & “no health & safety regulation”), and there now remain only two fresh pineapple operations remaining in Hawaii: one on Maui, and another on Oahu. And that quandary is an entirely separate, yet related, problematic issue.

However, much of what we eat has been commercially processed in volume. And I mean in HUGE volumes! In America’s factory food processors, a fairly common ingredient is

Reaching the End of Life: What Do We & Loved Ones REALLY Need?

Recollecting, one of my patients was similarly diagnosed, suffering terminal lung cancer of the small cell carcinoma type, and had one lung removed. He had presented to the ED (Emergency Department) with extreme hypoxia (lack of oxygen), to such an extent that his lips had a distinctive blue cast to them. His oxygenation was so exceedingly poor, that he would turn in bed, and his sats (oxygen saturation level) would drop to 70% – neither a good, nor one that would sustain life.

In conversation with him, I asked him what he wanted to have happen to him, how he wanted things to turn out for him. He wasn’t under any misguided notion about his state of well-being or health and wanted to depart the ICU.

He said, “I want to go home to die.”

I responded by saying, “We want you to go home too. Let’s see what we can do to get you back there.” At that point, I began some very simple teaching about his breathing. He was a habitual mouth breather, and he knew it. I’d glance up at him, and his mouth would be gaping open as he watched teevee. Problem was, that every time his mouth opened, his sats dropped, even though he was receiving high flow O2 therapy via specialized nasal cannula.

So I instructed him that by keeping his mouth closed and breathing through his nose, his sats would increase. And barring any other unforeseen circumstance, were his sats to consistently maintain above 90%, that would be the greatest step toward his objective to go home.

At the end of my shift, he was consistently satting 98%.

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Doctors are practicing irrational medicine at the end of life

by Monica Williams-Murphy, MD on September 22nd, 2012, in Physician

I just took care of a precious little lady, Ms. King (not her real name), who reminded me that, too often, we doctors are practicing irrational medicine at the end of life. We are like cows walking mindlessly in the same paths; only because we have always done things the same way, never questioning ourselves. What I mean is that we are often too focused on using our routine pills and procedures used to address abnormal lab values or abnormal organ function, to rightly perceive what might be best for the whole person, or even what may no longer be needed. Our typical practice habits may in fact become inappropriate medical practiceat life’s end.Ms. King was a case in point: She was a 92-year-old nursing homepatient on hospice for metastatic breast cancer. Ms King had been transferred to the ER for a sudden drop in blood sugar, presumably due to her oral diabetes medication. Her appetite had apparently been trailing off, as is common at the end of life, and her medication appeared to have become “too strong.” Her glucose level had been corrected by EMS during her trip from the nursing home to the Hospital, so when I came into see Ms King she was at her ‘baseline.’I opened the door to bed 24 and a grinning little white-haired lady peered at me from over her sheet. “Hi,” she said greeting me first.“Hi, Ms King,” I smiled back at her and picked up her hand.

She reached over with her free hand to pat me on my forearm, “You sure are a cute little doctor,” she said smiling.

I couldn’t hold back a little laughter. “Well, you sure are a cute patient too,” I smiled and winked at her.

She winked back at me.

“Wow, this is the most pleasant 90-year-old I have cared for in a while,” I thought to myself.

As we chatted it became clear to me that she had some mild dementia but had no pain or complaints at the time. She just said, “I think I had a ‘spell’” ( a “Southernism” for some type of unusual and undefined episode of feeling ill or fainting); and “I’m not hungry” when I offered her food.

Leaving her room still smiling after our pleasant exchange, I went back to look at her medical record from the nursing home and two things immediately struck me:

Former Tennessee Senator & Cardiothoracic Surgeon Bill Frist, MD enters healthcare dialogue

Face it. Sooner or later, you’re going to die. Death is a part of life. Making a decision about whether or not you want to be connected to belts, tubes, hoses & pumps to circulate your blood, food & oxygen when your body would have naturally expired is essentially what the discussion is about.

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The Bill Frist ℞

By: Brett Norman
September 16, 2012 11:06 PM EDT

Meet former Sen. Bill Frist, a renegade “Obamacare”-loving Republican who is in the mood for some real bipartisanship.

Yes, the same Frist who as Senate majority leader led an army into the culture wars over Terri Schiavo and whose efforts in 2004 to unseat his then-rival, Minority Leader Tom Daschle, led to a nasty — and personal — Washington battle royal.

Now, Frist is pushing for a national conversation on end-of-life care and dismissing “caricatured”talk of death panels. He’s committing Republican heresy in endorsing elements of the loathed Affordable Care Act. He’s standing shoulder to shoulder with Daschle in search of a bipartisan way to tackle one of the thorniest problems around: how to get control of health care costs before they sink the economy.

Frist is pushing for a national conversation on end-of-life care. | AP Photo

The Frist-Daschle reconciliation, in particular, is a source of amazement to some longtime Washington observers.

“I didn’t think they would ever talk again,” said Bill Hoagland, a budget expert and former aide to Frist who has joined the duo on a health cost control initiative at the Bipartisan Policy Center. “I was surprised, pleasantly, that they would work together.”

Daschle told POLITICO, “He’s been a very important partner and I would say has become a friend in spite of the fact that we’ve had a difficult history.”

“That is past and we now find much more in common than not,” he added. “We both know that we need to find a consensus way forward.”

Frist, a heart and lung transplant surgeon who is now focused on research and policy, is working on

News for the “Medical Marijuana”/420 crowd: Israeli firm grows “highless” marijuana strain

What if the so-called “medical marijuana” proponents could have their cake, and eat it to?

That is, what if they could have the “benefits” they claim they derive from smoking marijuana, while NOT having its intoxicating effects?

Would they still smoke it?

That would tell the story.

It certainly would.

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What a drag, Israeli firm grows “highless” marijuana

A worker tends to cannabis plants at a plantation near the northern Israeli city of Safed June 11, 2012. REUTERS-Baz Ratner

By Maayan Lubell SAFED, Israel | Tue Jul 3, 2012 9:48am EDT

(Reuters) – They grow in a secret location in northern Israel. A tall fence, security cameras and an armed guard protect them from criminals. A hint of their sweet-scented blossom carries in the air: rows and rows of cannabis plants, as far as the eye can see.

It is here, at a medical marijuana plantation atop the hills of the Galilee, where researchers say they have developed marijuana that can be used to ease the symptoms of some ailments without getting patients high.

A worker tends to cannabis plants at a plantation near the northern Israeli city of Safed June 11, 2012. Credit: REUTERS/Baz Ratner

“Sometimes the high is not always what they need. Sometimes it is an unwanted side effect. For some of the people it’s not even pleasant,” said Zack Klein, head of development at Tikun Olam, the company that developed the plant.

Cannabis has more than 60 constituents called cannabinoids. THC is perhaps the best known of those, less so for its medical benefits and more for its psychoactive properties that give people a “high” feeling.

A worker tends to cannabis plants at a plantation near the northern Israeli city of Safed June 11, 2012. Credit: REUTERS/Baz Ratner

But cannabis also contains Cannabidiol, or CBD, a substance that some researchers say has

“Physician, heal thyself.”

For many years, patients have increasingly complained that physicians “bedside manner” toward their infirm patients has been less than compassionate.

Such charges have led to decreased patient satisfaction, among other undesirable results.

So, what we really wanna’ know is…

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Can Doctors Learn Empathy?

June 21, 2012, 2:52 pm, By PAULINE W. CHEN, M.D.

My colleague loved performing surgery as much as anyone I had ever met. Every morning he bounded into the hospital, full of energy and cheerful anticipation of the day’s surgical schedule, his prominent mouth stretched into a broad grin.

“Too bad his foot is always in it,” another doctor whispered one day as our colleague passed by.

The sad truth was that despite his gusto, patients often complained about our colleague. He was brusque when the moment required sensitivity, flip when the conversation was grave, and heavy-handed when the situation called for a light touch. Just a few days earlier, we were shocked to learn he’d bluntly told an elderly war hero in the hospital for his diabetes, “I need to cut off your leg.”

“He sure doesn’t lack

Pradaxa & Xarelto: Are they worth the risks & costs?

What dangers lurk ahead for new “blood thinner” medications?

Could we unwittingly be participating in our own destruction?

Not only that, but these new medications are exorbitantly expensive, as well.

Are they worth it in the long run?

Should we continue to use the ready stand-by?

The new meds have no antidote. The old one does.

Too little too late, or too much too soon?

Are we playing with fire?

Only time will tell.

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Insight: Top heart doctors fret over new blood thinners

6:50am EDT, 14 June 2012

By Ransdell Pierson

NEW YORK (Reuters) – For millions of heart patients, a pair of new blood thinners have been heralded as the first replacements in 60 years for warfarin, a pill whose hardships and risks have deterred many from using the stroke-prevention medicine.

But growing complaints of risks and deaths tied to the new crop of drugs have made some top U.S. cardiologists hesitant to prescribe them. Some are proposing a more rigorous monitoring regimen for when they are used.

Most concerns revolve around Pradaxa, a twice daily pill from Boehringer Ingelheim that was approved by the U.S. Food and Drug Administration in October 2010 to prevent strokes in patients with an irregular heartbeat called atrial fibrillation. It was the first new oral treatment for that use since warfarin was introduced in the 1950s.

“The good news is

New Hope in Cancer Treatment May Soon Be Widely Available

In a nutshell, cancer is simply a case of good and normal cells which have “gone bad,” which are typically characterized by rapid reproduction of those mutated cells, accompanied by the development of its own network of blood vessels to feed its growth (angiogenesis).

The initial findings in this research are indeed promising.

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Drug Helps Defense System Fight Cancer

June 1, 2012 By ANDREW POLLACK

CHICAGO — One of the great frustrations for researchers in the war on cancer is that the body’s own defense system does not do a better job fighting the disease. Tumors, it turns out, have a molecular shield that repels attacks from the immune system.

Now, a new study says, an experimental drug is showing promise in disabling that shield, unleashing the immune system and causing shrinkage of some lung, skin and kidney cancers that had defied treatment with existing drugs.

“We are seeing responses in heavily treated patients — three different cancers, one drug,” Dr. Suzanne L. Topalian, a melanoma specialist at Johns Hopkins University and lead investigator in the study, said in an interview. “This is a group of patients whose life expectancy was measured in a few months.”

The results are from

MDs abandon Family Care, NPs step up to Care

A long-term trend in medicine in the United States has been that medical school students continue to abandon Family Care and Rural Practice.

The corollary trend among Advance Practice Nurses & Nurse Practitioners – many whom must also pass National Board Certifications in their area of practice – has been to fill the void formed in the delivery of healthcare by physician abandonment. Typically, the argument given for such abandonment is pecuniary. That is, by the time the medical student graduates from medical school & residency to assume full and independent practice, their debt load is not merely burdensome or impractical, but almost wholly impossible to repay.

More recently, however, medical schools and public health authorities have acknowledged the error of allowing that deterioration and abandonment to occur, and have begun to promote Primary & Family Care among medical schools and their students. Such strategies include not merely the promotion of community and the advantages of rural independent practice, but include full-ride scholarships while in medical school.

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Nurse practitioners look to fill gap with expected spike in demand for health services

By Sarah Kliff, Published: May 12

President Obama’s health-care law is expected to expand health insurance to 32 million Americans over the next decade. Health policy experts anticipate that

Chinese Junk: It ain’t just cheap crap made in China. It’s also hocus pocus herbal faith healers.

Kung Foo Panda.

Yeah.

It’s Chinese JUNK, folks.

Yes, I’m aware that’s a pun.

But, this AIN’T punny.

It’s your life we’re talking about.

So… who do you trust?

Something that has DEMONSTRATED SCIENTIFIC EVIDENCE – or some hocus pocus baloney baloney which is the equivalent of an old wives tale with utterly NO SCIENTIFIC EVIDENCE to support its specious claims?

Your “bullshit” detectors should be pinging 100% every time you pass by some “herbalist’s” corner.

If for no other reason, consider this: There is NO inspection of any ingredients used in such so-called “medicine.”

So, yeah… you could be ingesting arsenic.

Why?

Because there’s no inspection required.

Good luck!

And besides… are you really gonna’ believe that some root, gall bladder of bear, or powdered horn of an endangered specie will genuinely cure you?

Or, will it only relieve the symptoms of your wallet?

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Logo of Jiangxi University of Traditional Chinese Medicine ---

Samples of traditional Chinese medicine are found to contain harmful ingredients

By Kai Kupferschmidt, Published: April 23

Traditional Chinese medicine is enjoying increasing popularity all over the world. But two recently published studies show that the treatments can be harmful. The papers focus attention on the fact that not all of the ingredients in TCM treatments are listed, or even legal, and that some can cause cancer.

Critics have long warned that some mixtures can also contain naturally occurring toxins; contaminants such as heavy metals; added substances such as steroids, which can make them appear more effective; and traces of animals that are endangered and trade-restricted.

Now, researchers in Australia have investigated the issue using modern sequencing technology. The team analyzed 15 TCM samples seized by Australian officials.

“We took these traditional preparations, smashed them to pieces and extracted the DNA from the powder,” explained molecular geneticist Michael Bunce.

Some products contained material from animals classified as vulnerable or critically endangered, such as the Asiatic black bear and the Saiga antelope, just as the producers of the products claimed. But often, the medicine also harbored ingredients not mentioned on the packaging, the team reported online in PLoS Genetics.

In the herbal preparations that they tested, Bunce and his colleagues found

The Digital Pushback: Resistance to i-Progress in e-Medicine

What would it be like if you could to to your clinician’s office, and within a few minutes have a complete analysis of your blood done to detect whatever bug might be growing in there simply by the DNA of the organism?

It’s being doing now.

But why is there resistance to progress?

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The Wireless Revolution Hits Medicine

• Updated April 16, 2012, 11:42 a.m. ET

Eric Topol talks about the upheaval that’s coming as the digitization of health care meets the smartphone

By RON WINSLOW

After 14 years as chief of cardiovascular medicine at the Cleveland Clinic, Eric Topol moved to La Jolla, Calif., in 2006 to become director of the Scripps Translational Science Institute, which was established to apply genetic discoveries to personalized medicine. Three years later, he helped launch the West Wireless Health Institute, for which he is vice chairman and which is investigating use of wireless technology in the delivery of health care.

The convergence of these two fields—genomics, marked by the rapidly plummeting cost of sequencing a person’s entire genetic code, and wireless, with its flurry of innovative health-care apps—led Dr. Topol to write “The Creative Destruction of Medicine,” a book that offers an illuminating perspective on the coming digitization of health care. It’s also a reminder that while medicine is one of the globe’s premier drivers of innovation, it is also a conservative culture that now finds itself buffeted by transformational change.

The Wall Street Journal’s Ron Winslow discussed the implications with Dr. Topol. Here are edited excerpts from the conversation:

Unnecessary Boundaries

WSJ: Let’s start with the title. “Creative Destruction” is a provocative term. What needs to be destroyed?

DIGITAL DOCTOR Eric Topol advocates the transformative power of technology like the MinIon, a disposable device being developed to sequence parts of an individual’s DNA; a mobile patient monitor enabled by an iPhone app; the Zio patch, worn above the heart to check for irregular heartbeats; and a contact lens embedded with a chip to measure eye pressure for people with or at risk of glaucoma.

DR. TOPOL: There are two levels. One is that in medicine, everything we do essentially is

“No doctor ever asked me questions like that before.”

From a holistic healthcare perspective, a problematic issue that remains a common thread among many healthcare practitioners is the notion that a patient is a collection of symptoms, problems to be solved, or diseases cured.

This is not some witchcraft mumbo jumbo hyperbole, akin to the fallacious notion that frequently accompanies “naturopathic” ideology, which itself is wholly without any merit, scientific or otherwise… save that some damn fools spend money on that snake oil peddled by unscrupulous vendors.

This simple idea is that we are an entire collection of things – emotions, thoughts, physiological symptoms and more – all work together to make us who we are. It’s kinda’ like asking the proverbial question, ‘which leg of a three-legged stool is most important?’

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The Simple Idea That Is Transforming Health Care

A focus on quality of life helps medical providers see the big picture—and makes for healthier, happier patients

By LAURA LANDRO

• Updated April 16, 2012, 1:32 p.m. ET

A very simple question is changing the delivery of medical care: How is your health affecting your quality of life? Laura Landro explains on Lunch Break. Photo: Robert Neubecker/WSJ.

A very simple question is changing the delivery of medical care: How is your health affecting your quality of life? Laura Landro explains on Lunch Break. Photo: Robert Neubecker/WSJ.

A very simple question is changing the delivery of medical care:

How is your health affecting your quality of life?

For decades, numbers drove the treatment of diseases like asthma, heart disease, diabetes, and arthritis. Public-health officials focused on reducing mortality rates and hitting targets like blood-sugar levels for people with diabetes or cholesterol levels for those with heart disease.

Doctors, of course, are still monitoring such numbers. But now health-care providers are also adding a whole different, more subjective measure—how people feel about their condition and overall well-being. They’re pushing for programs where nurses or trained counselors meet with people and ask

Soon, the USA will be only 30 years behind in healthcare

Unless one travels in medical or healthcare circles, it’s highly doubtful that ICD-9 codes mean anything.

Why?

ICD stands for International Classification of Diseases, or more accurately, International Statistical Classification of Diseases and Related Health Problems. But it’s known as ICD.

So what’s the “9” for?

It means it’s the 9th revision.

And what good is ICD-9?

It’s a means of tracking disease.

And, to put things in perspective, while the article below would tend to infer that a one year delay might be a bad thing, consider that the work upon ICD-10 has been ongoing since 1983, and was