Medical Cannabis Journal

Lessons from the Road

By Barbara Mackenzie (Colorado)

06-28-2010

In 2005, after the 3 year San Diego Federal medical marijuana court case that ended with the death of my partner, Steve McWilliams, I began the long arduous journey to restore my health once again with cannabis, having severely regressed in those 3 years of not being allowed to use it.

Due to patient concerns regarding cultivation by 2005, I was unable to resurrect the collective model Steve & I had worked with SD's Medical Cannabis Task Force to approve in 2003. In early 2006, it became financially necessary to put my belongings in storage and move into my van. I was able to travel, staying with many friends and family as well as learning how to sleep on the streets. I recently was able to relocate into a home in Colorado.

All who took me in were kind and generous, often in the midst of their own financial and physical difficulties. Many were patients and fellow activists trying to cope with the challenges of California's evolving medical cannabis law and the need for affordable and adequate cannabis. It is the concern of patients and activists regarding the continuing problems of implementation expressed to me during that journey that I am addressing here.

Much of what I observed and learned echoed problems, issues and concerns that we had been dealing with in San Diego for years yet there were differences and changes after 2006 that gave hope at the same time adding new worries including, full access at affordable levels and the viability of all cultivation methods.

Dispensaries had become a reality, but often were not able to meet all patients' needs or to maintain a presence due to continual issues with local politics and unsupportive law enforcement. The concerns of the patients that came out of many discussions during my time on the road are presented below and are based on data from 30 individuals I had contact with from February 2006 until May 2009 living in the following counties: San Diego, Imperial, Riverside, Los Angeles, Ventura, Marin, and Mendicino. Patients' ages vary from the late-twenties to the late-seventies.

The worries of these patients were also related to me by many others in my long travels throughout California. Included in the overall picture are observations from my own health history as well as from the many patients Steve and I worked with since 1997.

Despite the passage of The Compassionate Use Act of 1996 and legislation to add other protections, those with knowledge of medical cannabis are fully aware of the long, difficult fight it has been to be able to benefit from those measures. Availability depends on locale, financial means and changing political conditions which may threaten access at any given time due in large part to the ignorance of local officials and populations as to what the law actually allows and the resistance to the law by many.

Those that I have spent time with had all been active in medical cannabis on some level since 2005, with 33% having been involved with Prop 215 since the 90's. In looking at patients' concerns, diagnosis is the most important aspect of understanding an individual's needs and anxieties.

40% had more than one qualifying diagnosis which can affect the type of cannabis a patient requires, both in strains and in application. The most common combination of diagnoses was chronic pain accompanied by depression. Often, as in my case of chronic pain, depression and PTSD can be a precipitating factor in accidents. Using cannabis to treat the pain also gives added benefits to dealing with long-standing psychological trauma.

In order to get an overall picture of the core needs of patients, I have only used the primary diagnosis for the statistical analysis. When working with more than one diagnosis, the information related to other diagnosis included here can be used to integrate the additional medical requirements.

Of the 30 patients interviewed, 67% were being treated for chronic pain. Their ages ranged from the late 20's to mid 60's. The cannabis usage among most chronic-pain patients ranged from 4 to 10 grams per day, with leaf needed for ointments and low THC edibles, as well as high THC bud for inhalation. Generally Indica dominant strains are preferred.

The second largest population group, 20%, was diagnosed with depression either by itself or as Bipolar Disorder. The dosage used by those with depression averaged 2-3 grams per day with edibles added when available. Those with Bipolar Disorder averaged 5-7 grams per day. These dosages are based in large part on what was available with many factors affecting that availability. Sativa dominant strains were generally preferred but that was not as predictable as with chronic-pain and seemed to vary more with Bipolar Disorder. The edible formula also varied from the chronic-pain in that edibles with higher THC content were preferred.

The remaining 13% of patients had diagnosis including optical problems, H.I.V. and cancer. Sativa was preferred by all diagnoses, but edibles were preferred with leaf containing little THC.

Of overall riding importance for the majority of patients was to have an adequate, affordable and reliable cannabis source without fear of law enforcement. 93% of those surveyed had previous negative impacts from law enforcement actions. 66% had been personally raided since the passage of Prop. 215 with 77% losing the source of cannabis as a result of these raids

The loss of medicine due to police activity was the number one patient concern. Law enforcement raids not only directly harm patients' immediate health, they set up the fear factor that continues to create further damage to already weakened health states. Patients become afraid of growing their own if they have been doing so, which increases their costs, limits the plant material they need for edibles and ointments and if left without another local source, contributes to further health damage and early deaths. For those who have depended on dispensaries, the void can not be easily filled and many have little means to cultivate.

The fact that there is frequently not another source is too often the situation that a large portion of California's population has faced since the passage of The Compassionate Use Act of 1996. Even with the possibility of dispensing collectives and co-ops, the fact remains that they are found in select areas with many communities banning them and in many areas where they have been available it has become a political challenge with law enforcement and anti-cannabis community members uniting to negate the law in the attempt to provide workable solutions.

The loss of medicine due to police activity has both immediate and long term consequences for patients. After the raid on Steve & I in 2002, within less than 6 months, one of our cancer patients, who had been in remission and was beginning to start walking with the help of edibles, died. Another committed suicide due to loss of medicine. At the time of that raid we had been down to less than 10 patients, including ourselves. Those left disappeared, fearing contact with us and I do not know their fate.
The issue of being able to actually grow one's own medicine or to help others to do likewise was the next biggest stress for 67% of respondents. Cultivation conditions were also an issue, with 50% expressing concern for the need to grow outdoors to achieve the quality, quantity and leaf to bud ratio of the plant essential for the medical-applications required.

Patients want to have the highest quality medicine for all the methods that help with their health. This was an issue for 80%. It follows therefore that organic plants as well as quality-ingredients used in ointments and edibles be of top priority. The inhalation, ingestion or dermal -application of plant material can contain contaminants including, but not limited to, harmful petroleum based chemical fertilizers, mold, fungus, bacterial, viral and animal pollutants. This is a major issue no matter how and where it is grown.

Patients are generally dealing with compromised immune systems no matter what their diagnosis and a clean source of medicine is vital. Organic standards can be adhered to and despite the inability to have the medicine certified organic due to the federal government's current position; cannabis can be certified as clean green under the Clean Green Program. A free introductory video, as well as the process to be certified as a clean green grower, is available at http://mccdirectory.com/clean_green_pre-certification_part1.lasso. A link on that page leads to the National List of Allowed and Prohibited Substances, the products one does not want to use on medicinal cannabis.

The cost of medicine was a problem for 63% of patients in that it did not allow an adequate supply to fully treat their symptoms. In many cases patients had to add pharmaceuticals with harmful side-effects that they had previously been able to eliminate or sharply decrease.

Numerous had previously grown there own and this right had been limited by legal actions to themselves or others resulting in a reluctance to claim their right to grow. Additionally the use of alcohol was resumed or increased when cannabis availability was inadequate which also contributed to decrease functioning. In one of the thirty, increased alcohol consumption was a contributing factor in that individual's death. The increased use of prescription medications rose.

83% of patients reported a lack of enough cannabis to treat their symptoms even when cost was not a factor. Inability to grow outdoors contributed to not enough cannabis as well as increasing the cost. Prices reported ranged from $640 to $1,200 per quarter pound for outdoor-cultivation, solar greenhouses or small indoor grows through collectives.

Dispensary prices ranged from $45 for 3.5 grams of lower-quality medicine to $90 for 3.5 grams for high-grade cannabis with an average of $70 for 3.5 grams at many places. I have had reports of $120 per 3.5 grams but not seen it. The range per quarter pound for patients needing that amount at verified dispensary prices would be from $1,440 to $2,880 with the average price of $70 for 3.5 gm per quarter pound being $2240.

I can function with at least 3 ounces of very good quality Indica, what some would categorize as A-, per month. My cost at a dispensary averaging $70 per 3.5 grams would be $1,680 for a 30 day supply. This does not include leaf for ointment and edibles.

For those who grew there own, cost was lower, but time and energy required to produce a good crop was like any other gardening situation with the outcome dependent on knowledge and a wide variety of environmental conditions. The pleasure of growing one's own medicine is a determining factor in addition to cost for those who do so.

Edibles are available at dispensaries, but the ones I visited were making them with trim that was too high in THC and too low in the much needed non-psychotropic medicinal cannabinoid compounds. That is not to say that there are dispensaries operating differently, but I have yet to visit one that can fully meet my needs, or the many other patients I have had contact with.

I found only one dispensary out of the 14 I visited (7%) providing ointment, but that formula used too little cannabis to be as effective for pain that one with leaf in larger proportions would provide. All who I taught to make ointment using my formula, now swear by it and have a new appreciation for the need to grow plants with a high ratio of leaf.

I found a large number of patients and caregivers believed the larger cannabis leaves, including fan leaves, did not have much medicinal value. These leaves were usually thrown away. Most small trim goes into hash or into edibles with high THC, creating a product that can leave one high or sleepy and which can then affect alert functioning. Edibles with a higher ratio of the other cannabinoids which are more predominating in leaf provide different physiological affects which have big health benefits.

Those with depression find edibles made from trim with high THC to be helpful, but others, including chronic-pain patients, often find they do not help relieve their symptoms but leave them unable to maintain normal activity due to the psychotropic properties.

For those who use large amounts of cannabis on a daily basis, once the receptors are filled, one does not get high, but normal functioning, including mobility, become a reality. Both Steve & I were able to stay more focused with increased creativity. I have noted that with others also. For us edibles with some THC were not too overwhelming, but they did not offer as many positive benefits that those made with leaf.

Indoor grows do not produce the large amount of leaf that is found in outdoor grows, another reason the patients I worked with were concerned with the need to grow outdoors.

The compounds that are abundant in leaf, CBD, CBN, CBG and many others just beginning to be identified, have shown in recent studies to contain many valuable therapeutic properties. The use of the whole plant is becoming increasingly important for optimum health.

CBD, cannabinol, is non-psychotropic and makes up to %40 of the medicinal-compounds in cannabis extracts. Medically it is indicated for inflammation, anxiety, nausea, seizures and to inhibit cancer cell growth. Recent studies indicate effective treatment with CBD for schizophrenia and reduce growth of breast cancer cells. It also reduces intraocular pressure.

CBN, cannabinol, has weak psychotropic properties. It decreases heart rate, inhibits platelet aggregation and has anticonvulsive properties.
CBG is non-psychotropic with sedative effects, antibiotic properties and reduces intraocular pressure. The presence of CBG in leaf and it's benefit for glaucoma is why many glaucoma patients can get by using leaf when available.

Edibles and ointments made with leaf high in these cannabinoids help reduce inflammation, edema and pain from arthritis, fibromyalgia, and a host of other chronic-pain conditions. Such edibles help one sleep without feeling groggy in the A.M. and a few nibbles on cookies throughout the day to keep one calm, alert and functioning.

When we were growing our own with an abundance of leaf, I became so healthy I began to wonder if I had imagined the severe pain of my condition. As it takes a while for the cannabis receptors to empty out it was a few weeks after the Federal action in 2002 before I really noticed that I really was severely disabled once again. I have yet to return to that state of health.

Considering the wide spectrum of medical application for cannabis, it is important to be aware of the varying needs of individual patients. Many have more than one diagnostic use for cannabis which can affect the cannabis applications required as well as the amount and type of cannabis used.

Conditions for which cannabis is therapeutically effective were reported by the late Todd H. Mikuria M.D in 1999 with an updated accounting in O'Shaughnessy's Journal of the California Cannabis Research Medical Group which included additional conditions. The issue was released in 2007 but is not available on-line. Earlier issues of the journal with valuable medical information can be accessed at http://ccrmg.org/journal.html.

The medical diagnoses in the 1999 list number 155 and range alphabetically from ADHD to Whiplash divided into six diagnostic classifications: 1) Psychotherapeutic-Antidepressant /Anxiolytic, 2) Harm reduction substitute, 3) Antispasmodic/ Anticonvulsant, 4) Analgesic/ immunomodulator, 5) Appetite stimulate , and 6) Hypothernigenic & Other.

With this extensive range of conditions that are treatable with cannabis, it is understandable that meeting these needs is challenging, especially when having to fight for the right to do so. The concerns of patients related here are shared with others who use medical cannabis to treat conditions not yet disabling but which allow for improved functioning with equally positive health results. All have concerns when it comes to the ability to access adequate cannabis and to utilize it to help achieve one's fullest health potential.

Restoring health as well as maintaining and improving health to allow increased functionality is one of cannabis's greatest gifts. Its ability to provide pain relief, especially neurogenic, is beyond par. The freedom to use cannabis for health is what patients know to be the most beneficial in achieving that quality of health.
Understanding the wide variables encompassing the divergent needs of the broad base of patients is paramount to insuring that the freedom for health through cannabis is not only sustained but expanded to improve the quality of health care that this unique plant can provide.

© This article is copyrighted by Medical Cannabis Journal 06-28-2010

Colorado  

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