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Spring 2006
O'Shaughnessy's
Journal of the California Cannabis Research Medical Group

30 Doctos, 24 Nurses Earn Credits
Continuing Medical Education at Patients Out of Time Conference

By O'Shaughnessy's News Service

Given the cannabis-free curriculum provided by U.S. medical and nursing schools, “continuing education” is not the apt term, but more than 100 healthcare providers —including some 40 MDs— will receive credits for attending a conference on cannabis therapeutics in Santa Barbara April 7-8.
The event was organized by Al Byrne and Mary Lynn Mathre of Patients Out of Time, a Virginia-based advocacy group, with help from David Bearman, MD, and students from Santa Barbara’s NORML chapter led by Loren Vazquez.
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At Santa Barbara Conference, Irvin Rosenfeld holds a can of low-grade cannabis cigarettes sent him by the U.S. government. Heidi Wunszh demonstrates a delivery system that's easier on the lungs--the Volcano vaporzer.

Donald Abrams, MD, was instrumental in arranging CME credits through UC San Francisco. Continuing education units were arranged by the California Nurses Association for RNs and LVNs; the National Pharmacists Association for pharmacists; and Santa Barbara City College for family therapists and licensed clinical social workers.
Unsealing the evidence
George McMahon, Elvy Musikka, and Irv Rosenfeld, who get their cannabis through the federal government’s “compassionate use” program, were videotaped opening their sealed cans to prove that the cannabis provided by Mahmoud ElSohly —the only grower licensed by the Drug Enforcement Administration— contains sticks and seeds.
ElSohly recently testified at a federal hearing that the DEA should not grant a license to Lyle Craker, a botanist at UMass Amherst (and potential competitor). The administrative law judge who heard the testimony will get a tape of the can-opening and cigarette-shredding by way of rebuttal evidence.
Activist Rick Doblin, PhD, orchestrated Craker’s application in hopes of breaking the government’s monopoly and making cannabis available to more researchers. He told the Santa Barbara audience that he thought the administrative law judge is inclined to recommend that Craker be licensed. If the recommendation is positive, Doblin foresees a public campaign to pressure the DEA Administrator to grant the license. (Administrative law judges don’t make rulings, they make recommendations to the government agencies that employ them.)
Focus on Post-Traumatic Stress
Three speakers, including Al Byrne, discussed their use of cannabis to cope with post-traumatic stress. “That’s what it is,” said Byrne, “—not a disorder but a perfectly logical response to terrifying events.” Byrne experienced unforgettable trauma when he was in the Navy —first a training accident in which he was seriously injured and seven men died, then combat in Vietnam.
Christopher Largen and Erin Hildebrandt were sexually molested in childhood. Largen, a writer from Denton, Texas, contrasted the punitive treatment of marijuana users in our society with the leniency shown sexual predators.
Hildebrandt, who had been abused by a teacher in elementary school, runs a group called Parents Ending Prohibition based in Lafayette, Oregon. She pointed out the inherent creepiness of making schoolchildren pee in a cup, “even with the door closed or half closed.” It breaks down the child’s sense of personal sanctity and provides easy access for the potential predator.
In addition to the 100+ healthcare providers who signed up for continuing education credits, about 150 patients and caregivers attended the conference, which was sponsored by SBCC’s Center for Philosphical Education. “Doctors
have at least as much to learn from patients,” Bearman observed, “as patients have to learn from doctors.”
The event was formally called “The Fourth National Clinical Conference on Cannabis Therapeutics: The Mind-Body Connection.” The patient-doctor connection was striking. An equality and level of involvement prevailed that one wouldn’t find at a corporate medical conference (where doctors are catered to by sales reps from drug companies and accompanied by spouses uninterested in the talks).
Some 15 of the doctors present were associated with the Society of Cannabis Clinicians or had otherwised evinced a special interest in the field. By signing up for CME credits in Santa Barbara, another 25-30 were showing a willingness to learn and a certain amount of courage. Perhaps none will make cannabis a focus of their practice, but all came away with enhanced understanding of the science and better able to discuss the subject with their patients. It’s likely that they’ll issue approvals with more confidence and alacrity in the days ahead.
Intellectual conversions
One particularly significant intellectual conversion in Santa Barbara involved Jeff Stone, a pharmacist from Riverside County who is a member of the Board of Supervisors. Stone had voted against the licensing of dispensaries last summer because he doubted that cannabis had valid medical applications. What he heard at the conference changed his outlook. “There is medical value to cannabis,” Stone declared to a Desert Sun reporter upon returning home. As a politician he promised to “come up with a plan that ensures we have legitimate purveyors of medical marijuana.”
Stone’s turnaround, according to K. Kaufmann of the Desert Sun, “could help expedite a county ordinance allowing medical marijuana dispensaries, which could in turn serve as a model for Coachella Valley cities also wrestling with the issue.” Stone visited two cannabis dispensaries while in Santa Barbara.
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BILL BRITT, in well-accesorized scooter, runs the Association of Patient Advocates. Britt attends court cases involving medical marijuana "on an almost weekly basis." He said, "Doctors in Orange County have been so frightened that we had to bring doctors down from Northern California to see our patients."

Also present at the conference was Barbara Roberts, MD, a senior policy analyst at the National Office of Drug Control Policy under Clinton and Bush. She is joining Americans for Safe Access as a lobbyist. ASA’s Steph Sherer was introducing Roberts in Santa Barbara with a big smile on her face. “ASA couldn’t have a better voice in Washington,” said Sherer. Roberts didn’t look too sad, either, to be on the side of truth and justice at last, in the warm afternoon sunshine, overlooking the Pacific from the most beautiful city college campus in the U.S. (If only they hadn’t plunked those “temporary” buildings on the lawn...)
Standard of Care
On a panel of California doctors, Arnold Leff, MD, and Frank Lucido, MD, offered practical advice for colleagues approving cannabis use by patients.
Leff is a Santa Cruz practitioner whose specialties include family medicine, AIDS, and geriatrics. Many members of the Wo/Man’s Alliance for Medical Marijuana are among his patients, and he has worked closely with organizer Valerie Corral over the years.

Leff warned that a heroin epidemic would ensue if the marijuana prohibition was enforced.

Leff’s involvement with marijuana dates back to the 1960s. As a captain stationed at an Air Force base in Northeast Thailand, he advised the brass not to send dogs into the Enlisted Men’s barracks to search for marijuana. He predicted that a heroin epidemic would ensue if the marijuana prohibition was enforced, and pointed out that the officer’s quarters were never searched. For offering his advice, Leff was reassigned to another duty station.
After returning to civilian life, Leff was hired by (President Nixon’s) Special Action Office for Drug Abuse Prevention to deal with the heroin epidemic he had anticipated. “It was the last time the White House drug-abuse policy office was run by a physician,” Leff noted. “Since then it’s been generals and administrators —even under Clinton.”
Problems to bear in mind
Leff listed a number of problems that doctors entering the field should bear in mind. “Non-uniform product. Contaminants which might produce potential adverse effects. Therapeutic availability may be inconsistent. Marijuana is an illegal substance and is now being grown by conglomerates that are not being careful of the environment. Marinol is a uniform product that works for some, but dosing is very tricky and it’s a costly drug.”
Leff thinks marijuana ought to be treated like other herbs available at health food stores. “Given its safety, perhaps it should not have been medicalized. But since it has been medicalized, the responsibility changes. Once a patient walks through a physician’s door, a standard of care is required: appropriate diagnosis and appropriate follow-up. There are difficulties confirming some diagnoses in those who are mentally ill and those who use more dangerous substances... It really is our responsibility, even if they come in with medical records, to confirm that that diagnosis is correct.”

“We need to bring back a good doc for drug czar, instead of generals.” —Arnold Leff, MD

Leff acknowledged that there are “poor quality patients who share their meds, patients who sell meds inappropriately.” He also mentioned “the issue of smoking in public and being respectful of others... Since we have red benches [designated areas for cigarette smokers] perhaps we also need blue benches.”
On the national political front, Leff does not expect the judiciary to advance the cause of medical marijuana. “We need to make it an important subject to Congress and the American people. If there’s a congressional change in the near future, we need to make the most of it. We need to bring back a good doc as drug czar instead of generals, and, of course, reorganize and redirect the DEA the NIDA and the FDA. We also need to change some treaties.”
Risk of Medical Board Scrutiny
Lucido did not try to sugar-coat the situation for prospective cannabis consultants. He decried the commitment to prohibition of the California Narcotics Officers Association, whose opposition to Prop 215 didn’t end after the voters passed it.
The Medical Board of California (MBC) is controlled by law enforcement and/or their legal staff who work closely with the Attorney General’s office. “Doctors are afraid of the Medical Board — even good doctors,” said Lucido.
“ The Board has initiated several inappropriate investigations of cannabis recommending physicians, essentially all initiated by reports from various categories of law enforcement.
“ My own inappropriate investigation came as a shock,” Lucido said, given his confidence in his practice standards. In response he began attending quarterly meetings of the Board and founded MedBoardWatch.Com to report on their doings.

DANIELE PIOMELLI, professor of pharmacology and director of the Center for Drug Discovery in the UC Irvine School of Medicine, is trying to develop a sythetic cannabinoid that will not affect the brain but will block pain at the site of an injury. "Cannabis offers fantastic ground to develop new compounds," he said, "and medicine needs them."

Activists are working ceaselessly to implement the law, Lucido said, and “just last week the City of Emeryville, was forced to pay a patient $15,000 for having taken the patient’s medicine.
“ In spite of the adverse Raich Supreme Court decision, I see victory ahead for doctors and patients who can demonstrate responsibility and credibility. Responsible doctors and their responsible patients will be most protected.”
David Bearman, MD, recounted the case in which he ultimately prevailed against the Medical Board for violating the privacy rights of his patient by subpoenaing his medical records. A published decision by The California Appellate Court of the 2nd District said that the Medical Board didn’t understand Prop 215; didn’t understand the law affecting privacy rights; and lied about not investigating doctors solely for recommending cannabis.
Bearman said that Joe Allen, the former district attorney of Mendocino County, is filing a civil rights lawsuit in federal court on his behalf, seeking $115,000 in damages for his ordeal.
“ We must move the media to seeing how cannabis actually improves the quality of life for some —that with cannabis they can work, they can drive, they can care for their kids,” said Bearman.
The Santa Barbara News-Press ran a front-page story April 8 focusing entirely on a brief, “profanity-laced” talk by Montel Williams, who urged his audience to expose politicians who smoke marijuana. Williams said he was “tired of being out here all alone” —as if the room wasn’t full of people who have taken risks to oppose prohibition. The TV host’s talk was a sidebar to the conference and should have been a sidebar in the paper.
The UC Santa Barbara NORML chapter, whose members helped stage the conference, presented Tod Mikuriya, MD, with a plaque ‘in recognition of a lifetime of work, courage and fortitude in fighting the insane drug laws of our time and almost single-handedly reintroducing the medicinal application of cannabis to over two generations of physicians.”
Mikuriya praised his longtime hero, W.B. O’Shaughnessy (see story on page 25), and decried “non-medical forces that have insinuated themselves into the practice of medicine in the most ungodly ways. We see victims around us here today— Dr. Mollie Fry and her husband, attorney Dale Schafer, have been forbidden from having appropriate medication for the treatment of their conditions and have been forced to take medication that is both sickening and diminishes their ability to mount a defense.
“ Another patient of mine, Robert Schmidt, who founded Genesis 4:29, was prevented from using cannabis or Marinol by federal prosecutors and non-medical bureaucrats in the pre-sentencing program. They poisoned him with Effexor, causing serious cardiac complications as well as gross edema and an inability to focus on mounting a credible defense.”


 

O'Shaughnessy's
O'Shaughnessy's is the journal of the CCRMG/SCC. Our primary goals are the same as the stated goals of any reputable scientific publication: to bring out findings that are accurate, duplicable, and useful to the community at large. But in order to do this, we have to pursue parallel goals such as removing the impediments to clinical research created by Prohibition, and educating our colleagues, co-workers and patients as we educate ourselves about the medical uses of cannabis.
 
SCC
The Society of Cannabis Clinicians (SCC) was formed in the Autumn of 2004 by the member physicians of CCRMG to aid in the promulgation of voluntary standards for clinicians engaged in the recommendation and approval of cannabis under California law (HSC §11362.5).

As the collaborative effort continues to move closer to issueing guidelines, this site serves as a public venue for airing and discussing these guidelines.

Visit the SCC Site for more information.