Kentucky and Medical     Marijuana:    1.9% Must Get Stoned     Jaclyn Engelsher
Should Kentucky EnactLegislation to Legalize theUse of Medical Marijuana?
Why Consider Considering? Need for research, not anecdotes KY leads the nation in non-medical use of  controlled pain re...
If all the other states jumped          off a bridge . . . Effective: CA, AK, OR, WA, ME, CO, NV, HI,  VT, MT, RI, NM, MI...
Current KY Law 218A.1421 - trafficking marijuana.    < 8 oz: Class A misdemeanor 1st, Class D     felony 2ed & subsequen...
Getting Around              Federal Law Illegal to possess, grow, or distribute since  1937 Can be enforced anywhere in ...
Marijuana Basics   Pharmacokinetics   Pharmacodynamics   Short term effects   Delivery methods     Smoke     Vapor  ...
Current “Recommended”          Medical Uses   Chemotherapy related N/V   AIDS/HIV Wasting Disorder   Terminal Illness/C...
Other “Recommendations”                   (“but it really works, doc”)   Alzheimers Agitation/Prevention   Asthma & Brea...
But . . . We Already Have   Medical Marijuana!
Marinol Synthetic delta-9-Tetrahydrocannabinol (THC)  approved by FDA for n/v & appetite stimulant Low diversion & abuse...
Coming Soon . . . Sativex Approved in Europe & Canada In Phase III in US clinical trial Indicated for neuropathic pain ...
GO               vs       NO Provides alleviating          Efficacy of existing  therapy for multiple           & emergi...
Recommended Model        Legislation for KY MD in certain specialties may certify MJ for use in  specific, pre-determined...
How Would You Vote?
Sources Consulted   AMA Policy: Medical Marijuana (2009). Retrieved from    http://medicalmarijuana.procon.org/sourcefile...
Sources Consulted   Net Resources International (n.d.). Sativex: Investigational cannabis-    based treatment for pain an...
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Kentucky and Medical Marijuana: 1.9% Must Get Stoned

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This presentation was created for a health policy class as part of a nursing practice doctoral program. It reviews the pro-and cons of creating a health policy to allow medical marijuana.

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  • Case studies, small cohort studies, anedotal; AMA called for more research on smoked product &quot;and related cannabinoids in patients who have serious conditions for which preclinical, anecdotal, or controlled evidence suggests possible efficacy&quot; ; because schedule I (no accepted clinical use) hard to do research and not FDA approved - &quot;Despite more than 30 years of clinical research, only a small number of randomized, controlled trials have been conducted on smoked cannabis. ” - not endoresement, just a call for rsearch - http://medicalmarijuana.procon.org/sourcefiles/AMA09policy.pdf 4th for stimulants; More people abuse rx drugs than cocaine, hallucinogens, inhalents, heroin combined;; Hydrocodone &amp; Xanax - under-prescribing, over-prescribing, short term therapy turns into long term addiction, unsatisfactory pain control, non-controlled substances higher addiction potential and “better” than non-controlled 2006 KY ranked #3 in MJ cultivation with a value of $4.5 - most is diverted to surrounding states - not including hemp production or selling to other states; expense related to plant eradication and law enforcement; mexican smuggling rings; highest % drug related arrests; nearly 90% possessions only 2007 KY #3 in nation of MJ arrests; 65% all drug arrests; 93% possetion only; 125 million in judical/legal, correction and policing 2006; fedral destruction and investigation http://medicalmarijuana.procon.org/sourcefiles/AMA09policy.pdf Gettman, John (2007). Marijuana arrests in the United States (2007): Arrests, usage, and related data. The bullitin of cannibus reform. http://www.drugscience.org/Archive/bcr7/Gettman_Marijuana_Arrests_in_the_United_States.pdf National Instituteon Drug Abuse (Prescription drugs abuse and addiction Office of National Drug Control Policy: Drug Policy information clearinghouse: State of Kentucky profile of drug indicators; Feb 2008
  • Effective (13): no criminal penalties, recommend by MD - some states specify conditions, CA does not; limits amount allowed to possess/cultivate Workable (1) - taken to court with max fine 100 if can show medical necessity, relience on dealers Research (9) - cumbursome and difficult to enroll Symbolic (9) - prescribe in verbage which caanot be done due to schedule I classification; recognize value but no pt access; require federal supply 14 states none
  • Alaske, Hawaii, Montana, Tennessee and DC took out of schedule one Obama clled off the feds as long as individual use was in strict compliance with state law - still raided 4 CA dispensaries suspected of drug dealing
  • Pharmacokinetics: Peak plasma 10 minutes after smoking, 2-3 hour psycoactive componant, Half-life 1+ days, Lipid soluble and detectable 30+ days, Elimination1/3 renal; 2/3 fecal, Metabolized by cytochrome P450 system Pharmacodynamics: 460 compounds; 60 cannabinoids, CB1 &amp; CB2 receptors in brain &amp; immune system, Neuronal excitability &amp; neurotransmitter release Short Term Effects: Dry mouth, Red eyes and decreased IOC, Change in sink sensation, Increased heart rate, Muscle relaxation, Memory, concentration, and coordination impairment Smoking (full/partial plant) Effects &lt; 1 minute Respiratory illness, CA, effective 1-2 hours Vaporization Greater effect than smoking, less respiratory/ cancer risk, less product Expensive, not as effective, 1-2 hours duration Ingesting (oil, plant, tincture, butter) Safer, less psychogenic effect, easy to modulate, longer lasting effects 30-90 minutes for effect, weaker, “guessing” therapeutic dose, GI/Neuro SE
  •     Chemo - marinol vs smoked argument, but rx meds still better AIDS - helps gain weight but decreases immunity and smoked form increases bronchitis/pneumonia Pain - r/t arthritis evdence is anecdotal both sides; increase pain sensation vs less s/e, equal pain control and addiction; inebriation is not pain control; What the hell - they are going to die anyway! Glaucoma decreases IOP in frequnet doses - direct forms in development; 1978-1992 Compassionate Investigational New Drug Program glucoma fed provided MJ, AIDS It was used way back when . . . When they were still using sulfa and leaches
  • Asthma - short-term bronchodilation (to get the toxins in better) vs pulmonary symptoms &amp; dx and structural abnormalities GI - anecdotal with antiinflammatory arguments going both ways; largely anecdotal Epilepsy - induce and prevent case studies Hep - increase fibrosis, helps SE of meds Migraines - anecdotal M/s - montel williams &amp; makes more balance and posture problems Psych - antidepressednt but illusion b/a motivation, productivity, social/sociatial production not enhanced - helps symptoms, not root cause; increase risk of psychosis Touretts - induces calming, anxiety is a contributing factor to increase in symptoms
  • Chemo/AIDS 400 chemicals 4xs tar “ but I don’t want to swallow a pill” - well, smoke can make you nauseated too!
  • Side effects similar to MJ - “high” most frequent with other smoked Chronic high dose motivation, cognition, judgment, and perception Abrupt d/c - 12-48 hours w/d symptoms irrate, hot flash, sweat, insomnia, restless http://www.rxlist.com/marinol-drug.htm Marinol:MJ what Morphine:Opium
  • Like tinctures in 1930s
  • Problem with out health care (disease care) model: Don ’t fix whats broken, we just keep replacing the same bad parts Moral (degrade society, reduce MDs to drug pushers, against God) and emotional arguments (the people in pain, alcohol is worse and its legal) Farce = case for total legalization
  • Oncology, pain management, ophthalmology, neurology Links with Kasper Caregiver registration if unable to cultivate by self Non-profit, subject to inspection, minimum security/record keeping No possession or intoxication; not cover http://www.mpp.org/assets/pdfs/library/Model-Bill-One-Pager-1.pdf
  • Kentucky and Medical Marijuana: 1.9% Must Get Stoned

    1. 1. Kentucky and Medical Marijuana: 1.9% Must Get Stoned Jaclyn Engelsher
    2. 2. Should Kentucky EnactLegislation to Legalize theUse of Medical Marijuana?
    3. 3. Why Consider Considering? Need for research, not anecdotes KY leads the nation in non-medical use of controlled pain relievers and tranquilizers We are loosing millions of dollars in potential revenue We are spending millions of dollars in prohibition
    4. 4. If all the other states jumped off a bridge . . . Effective: CA, AK, OR, WA, ME, CO, NV, HI, VT, MT, RI, NM, MI Workable: MD Research: AL, GA, IL, MA, MN, NJ, NY, SC, TX Symbolic: AZ, CT, DC, IA, LA, NH, TN, VA, WI Expired/Repealed: AR, FL, NC, OH, WV (MPP, 2008)
    5. 5. Current KY Law 218A.1421 - trafficking marijuana.  < 8 oz: Class A misdemeanor 1st, Class D felony 2ed & subsequent offence  >8oz <5lbs: Class D felony 1st, Class C felony 2nd & subsequent  5+lbs: Class C felony 1st, Class B 2nd & subsequent  Possession >8z + intent to sell/transfer 902 KAR 55:020 - MJ and THC schedule I; Marinol schedule III
    6. 6. Getting Around Federal Law Illegal to possess, grow, or distribute since 1937 Can be enforced anywhere in the US Cannot force state authorities to enforce federal law Cannot force state to have identical federal law 99% of MJ arrests are by state & local, not federal, authorities States determine drug scheduling class
    7. 7. Marijuana Basics Pharmacokinetics Pharmacodynamics Short term effects Delivery methods  Smoke  Vapor  Ingestion
    8. 8. Current “Recommended” Medical Uses Chemotherapy related N/V AIDS/HIV Wasting Disorder Terminal Illness/ChronicPain Glaucoma
    9. 9. Other “Recommendations” (“but it really works, doc”) Alzheimers Agitation/Prevention Asthma & Breathing Disorders GI Disorders Epilepsy and Seizure Disorders Hepatitis C Migraines Multiple Sclerosis Psychological Disorders (including PMS) Tourettes syndrome
    10. 10. But . . . We Already Have Medical Marijuana!
    11. 11. Marinol Synthetic delta-9-Tetrahydrocannabinol (THC) approved by FDA for n/v & appetite stimulant Low diversion & abuse led DEA to move from schedule II to schedule III in 1998 Patch & inhaler under development Safe, regulated dose without chemicals or tar Longer onset & effect, increased psychoactive effects, only one active ingredient Metabolized by CP450 3A4/2C9 (USDEA, 2010 )
    12. 12. Coming Soon . . . Sativex Approved in Europe & Canada In Phase III in US clinical trial Indicated for neuropathic pain relief in MS and cancer Natural extract THC & CBD Spray delivery Less intoxication Statistically significant improvement compared to placebo/existing medications
    13. 13. GO vs NO Provides alleviating  Efficacy of existing therapy for multiple & emerging disorders pharmaceuticals Lower addiction potential than opioid analgesics  No reliable field Regulations ensure sobriety test potency & purity  “Recommended” Generates state revenue use is a farce & decreases spending  Risk>Benefit Benefit>Risk Lack of reliable clinical research
    14. 14. Recommended Model Legislation for KY MD in certain specialties may certify MJ for use in specific, pre-determined conditions for maximum 1 year Register with health department for ID tracking card Possess up to 6oz and 12 plants State-regulated, non-profit dispensaries Prohibit public use and driving Medical necessity defense not permissible Employers and insurers may restrict
    15. 15. How Would You Vote?
    16. 16. Sources Consulted AMA Policy: Medical Marijuana (2009). Retrieved from http://medicalmarijuana.procon.org/sourcefiles/AMA09policy.pdf Gettman, John (2009). Marijuana arrests in the United States (2007): Arrests, usage, and related data [Electronic version]. The bulletin of cannabis reform, 1-24. Retrieved from http://www.drugscience.org/Archive/bcr7/Gettman_Marijuana_Arrests_in _the_United_States.pdf Marijuana Policy Project (2008). State-by-state medical marijuana laws:How to remove the threat of arrest [PDF document]. Retrieved from http://www.mpp.org/assets/pdfs/download- materials/SBSR_NOV2008_1.pdf Net Resources International (n.d.). Sativex: Investigational cannabis- based treatment for pain and multiple sclerosis. Retrieved from http://www.drugdevelopment-technology.com/projects/sativex/
    17. 17. Sources Consulted Net Resources International (n.d.). Sativex: Investigational cannabis- based treatment for pain and multiple sclerosis. Retrieved from http://www.drugdevelopment-technology.com/projects/sativex/ Office of National Drug Control Policy Drug Policy Information Clearinghouse (2008). State of Kentucky: Profile of drug indicators [PDF document]. Retreived from http://www.ondcp.gov/statelocal/ky/ky.pdf U.S. Department of Health and Human Services, (2005). Prescription drugs abuse and addiction. National Institute on Drug Abuse Research Report Series [Electronic version]. Retrieved from http://www.drugabuse.gov/PDF/RRPrescription.pdf U.S. Drug Enforcement Administration (n.d.). “Medical” marijuana - The facts. Retrieved from http://www.justice.gov/dea/ongoing/marinol.html

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