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Minutes December 2001


MINUTES OF CCRMG 12/14/01 MEETING

Present: Tod Mikuriya (Facilitator), John Trapp, Mollie Fry, Dale Gieringer, Ling Wao, Richard Hansen, Jeff Hergenrather, Starr Hergenrather, Mary Jane Mikuriya, Stephen Ellis, Phil Denney, Jerry Mandel, Fred Gardner, George Fuller.


AGENDA:

1. Introductions.

2. Agenda review and approval.

3. By-laws amendments/changes – Sally Light, JD.

4.HIPAA Introduction, Code Sets and Transactions – John Trapp, TA.

5.Presentation by Mollie Fry and Dale Schafer on recent arrests.

6. Report: Berlin International Association for Cannabis as Medicine 2001
Congress on Cannabis and Cannabinoids
“Cannabis Substitution in the Treatment of Alcoholism and Other Drug Dependency”

7. Applications for clinical research programs.
UC San Diego Medical Marijuana Research Program – Jerry Mandel, PhD

8. Medical Board Cases Updates – Susan Lea, JD, CCRMG General Counsel

9. Civil & Criminal Cases – William Simpich, JD

10.Other – Letter to Hallinan – Tod Mikuriya

11. Next Quarterly Meeting.

12. Adjourn

1. Introductions.
The meeting began with a round of introductions.

2. Agenda review and additions. – Agenda was approved as-is.

3. By-laws amendments/changes.
(Presented by John Trapp, as Sally Light was not able to come to meeting):

Following is a list compiled by Sally Light, who has been researching and organizing CCRMG’s files:

1) 1) Need Board approval to make the following changes to minutes from 12/8/00 meeting minutes:
A, Motion was carried to amend Article VII adding Nurse Practitioners to Allied Health Professional’s list. Minutes will be changed to read “Article VIII.”
B. B. Motion was carried to enact $100 membership dues – this conflicts with By-laws. Minutes will be changed to call this “credentialing costs fee.”

2) Need resolution authorizing the removal of May Jane from Wells Fargo account:

Be it resolved that, as Mary Jane Mikuriya has resigned from the BOD, her name shall be removed from CCRMG’s Wells Fargo account #0296200363.

Also need two BOD members to sign bank form.

3) 3) Need to bring all the non-discrimination clauses in CCRMG’s documents into consistency with each other.
4) 4) Authorize Sally to correct typos and to make changes in By-laws and other legal documents to correct for congruence, no changes of substance would be authorized by this resolution.

APPROVED: As there were no objections, all these suggestions were approved by the BOD.

4. HIPAA Introduction, Code Sets and Transactions.
John Trapp distributed handouts of the HHS May 2001 packet. There are 6 sections, but only 2 have been addressed to-date. Page 5 has a list of codes that has now been given a 1-year extension to be implemented. John explained that there is not much information for small practices, but he will provide updates at future meetings.

5. Presentation by Mollie Fry and Dale Schafer on recent arrests.
Mollie said that her constitutional rights under the 1st, 4th and 5th amendments have been violated, that there has been no media coverage of this, and that she’s still in shock! She said that her written recommendation was seen by the feds as a conspiracy to violate federal law! She also said that she has tried her best to comply with the law since the major court decision of last year, and that, in her view, we must all work together to avoid being taken down. She explained that she was targeted because of her extensive MM research and because she was likely to go before Congress re: drug rescheduling. The feds seized all her research and files and computers. She is still waiting to hear about the court schedule!

A general discussion ensued about patient privacy standards vs seizure of documents, and the federal attack on the former now underway. Dale stated that “backdoors” of programs provided to the government may happen under duress (he cited the example of Microsoft getting off the hook after it provided such “backdoors.”).

Fred Gardner clarified the current legal status: In San Francisco, the Federal District Court’s injunction prevents the DEA from investigating any doctor’s recommendation. Ashcroft appealed this, and it remains to be seen whether the 9th district court will uphold the injunction. Ashcroft, of course, wants to go after the doctors. Also, Mollie’s & Dale’s situation does not come under the injunction, because they are charged with manufacturing and distribution, both of which are exempt from the court order.

Dale said that in her case, the feds apparently first investigated cultivation claims, obtained information, and used the pretext of “manufacturing and distribution” to make the arrest and to seize her files. In fact, this kind of persecution has been occurring for many years.

Mollie offered her floppy disk that she’s been circulating – it is a chain letter designed to build a grassroots groundswell to support a widespread economic boycott re: 215.

She also suggested going to the Medical Board (as the leading medical experts on MM) with recommendations re: MM standards & guidelines. A lengthy discussion was held – mentioned were 1) CCRMG creating a positive practice standard re: scheduling of drugs (Lockyer is dragging his feet on this); 2) being aware that the refill limit of 6-months means that a new physical exam is needed after that limit; 3) the irony of legally-obtained drugs that ARE dangerous as opposed to MM, and the giant profiteering by the drug manufacturers; educating physicians about MM – seminars, etc.

APPROVED: CCRMG will set up a committee to create “Best Practices” guidelines for MM. Three volunteered for this committee: Mollie, Dale and Stephen Ellis.

Tod also mentioned that CCRMG has received a small ($5,000) grant from the Zimmer Family Foundation, which CCRMG can use to move forward on becoming a credentialed group and to develop its infrastructure.

6. Report: Berlin Int’l Association for Cannabis as Medicine 2001
Congress on Cannabis and Cannabinoids
“Cannabis Substitution in the Treatment of Alcoholism and Other Drug Dependency”
Tod reported on his attending the Berlin conference. It was backed by European cannabis pharmaceutical houses. He presented a paper, “Cannabis Substitution in the Treatment of Alcoholism and Other Drug Dependency.” This presentation was based on his experience as a clinician, and those listening held exchanges and discussions about it.

He contrasted the scene in Europe with that in the US. A totally different atmosphere exists in Europe - there is no problem and no fear re: cannabis as a harm reducer in Europe, whereas, in the US, it is a giant problem (e.g., police actions against it, the concept of 12-steps programs, etc.). He stated that the Europeans were shocked and disgusted at the present situation in California.

Jerry reported that he wrote the paper for Tod. It was based on analyses and summaries of 104 of Tod’s patients, and he is continuing with additional patients. Jerry explained that this is an original concept, i.e., that alcoholism can be relieved by MM, and that the 104 patients were those who were alcoholics, and/or had alcoholic parent(s), and/or who had experienced major accidents. There was a pattern observed of a crisis being reached where the patient would start using cannabis, shifting the weight from alcohol use to cannabis use, and subsequently experiencing less pain and an improved quality of life. Jerry went to the histories and to the literature, as well as to the patients for details re: this shift to MM.

Tod also reported on the rapid progress re: medical cannabis in Europe. Some of the major companies attended the conference – GW Phar. (UK), Merck, Bionorica (recently added cannabis to its catalog of available medicines), and companies from Switzerland and Holland. In the UK, interesting clinical research is being done re: treatment of MS, with crossover potential for treating other conditions.

There was a general discussion about the fact that the FDA has hung up such research in the US, and the likelihood that Europe will leave the US “in the dust” when it comes to this research.

7. Applications for clinical research programs. UC San Diego Medical Marijuana Research Program.
Jerry said that MM is an appropriate topic for investigation and research via medical records – it’s easy to get records, and one can narrow the investigation to specifics. The question is, how to get paid to do it? He said that he’s not looked at the UC San Diego program, but that he has looked at the booklet from O’Connor Johnson, and he thinks they are still soliciting projects. However, his general impression is that they don’t want to support this kind of project; also, the size of their grants is small – below $100,000 per year.

Jerry also raised the question of how to gain access to the cannabis club patient registry, which contains 1,000s of cases – a rich resource for research. Patient authorization would be required, and he suggested that patients be asked “Are you willing to be part of a research project?” as part of their filling out the questionnaire.

Tod spoke of his “dream” of having a common face sheet with which everyone could combine data and do studies. He is interested in larger studies such as comparison and advocacy of different products, e.g., vaporizers over smoking, and also oral doses. (Mollie added that she wants to a study of her great results using larger oral doses for patients with chronic pain at night.)

Tod said that CCRMG exists for just this purpose – to combine information and to act in a collegial, scientific fashion.

Mollie said she has been using her 8-page questionnaire that has 32 points which she enters into her program (she’s done much research over the years). This includes patients rating 1) how their use of MM has affected their use of other drugs, and 2) MM’s effectiveness on their anxiety, frustration, anger, appetite, etc . Tod said this would be a good research project topic.

Tod summed up by saying that the common face sheet can combine everyone’s data and might be a good add-on to HIPAA. Also, this makes data portable. Mollie offered her data to CCRMG to be used for the face sheet and data-sharing. Others also chimed in, as everyone collects data – demographics, histories, etc. Tod emphasized the need for simplicity for data entry which can be used to develop medical practice standards.

The group reviewed the number of committees that CCRMG has: Medical Records Committee (acts in an executive function), Committee Reports, CCRMG Correspondence, Credentialing. (NOTE: this whole section was hard to decipher, as there were many side conversations going on.)

APPROVED: It was suggested and approved to review this topic (face sheet, data entry/sharing, collating data towards developing medical practice standards, etc.) before the next quarterly meeting on March 8, 2002. The review deadline is Jan. 31, 2002, and a rough draft will be sent via email to everyone. John will create an email list from today’s sign-in sheet.

Tod said that he’s going to apply for a George Soros Foundation grant to set up a statewide pilot project re: compliance with the Compassionate Use Act. Tod & John both explained that Tod’s web site already has some information – correspondence with the 58 counties, DAs, Boards of Supervisors, etc. So far, less than 1/5 of California’s counties have anything on their books – the state doesn’t act as if it really has a law. Someone (a man – off camera) said he believes this is a form of disability discrimination. Perhaps local resolutions could help here. Someone else pointed out that the CNOA web site has links to the AG’s web site – another indication of the hurdles to be overcome to educate the public re: 215.

Items 8 & 9 were postponed to the next meeting, as the presenters were not present.

10. Other - Letter to Hallinan – Tod Mikuriya
Tod Mikuriya and Fred Gardner have discussed the idea of writing a letter that would go to Hallinan asking him to approach Lockyer concerning the entire situation re: Prop. 215 and the federal raids/arrests/court action, and asking Lockyer to comply with Prop. 215. This approach prevents CCRMG, as a 501(c)(3) nonprofit, from violating the guidelines against direct lobbying. After general discussion, the BOD APPROVED writing this letter, and that the deadline for the first draft would be 1/14/02. Tod will draft it and circulate it to the other BOD members via email for feedback and sign-off.

11. Next meeting – Tod will send out an email about setting the date of the next quarterly Board meeting.

12.Adjourn. - It was moved, seconded, and passed, to adjourn the meeting.

Minutes prepared by Sally Light. March 5, 2002.


 

O'Shaughnessy's
O'Shaughnessy's is the journal of the CCRMG. 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. Read O'Shaughnessy's Online
 
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.