All right, that is what we're going to be talking about.
This isn't a laughing matter. It's not Cheech and Chong
medicine. General Barry McCaffrey called
this Cheech and Chong medicine in 1996, after the voters of the
states of Arizona and California approved the legalization
of medical marijuana in those states.
Cannabis is medicine. It's not a joke.
And let's get into that. There are at least 12 states
where it's legal. Maryland, whoops--
That's great. Okay, Maryland is questionable
because there you can use it as a defense
after you've been found guilty. It doesn't sound like
that's real legalization. Briefly, in the Chinese oral
history their materia medica goes back to 2637.
And either the second Chinese emperor or the mythical
Chinese emperor, also the God of pharmacy and agriculture
Shaun Nen is said to have discovered the medicinal
properties of cannabis. Sir William Osler, of course,
in his textbook of internal medicine written in the 1890s
in two subsequent editions, last one written, I think,
in 1916, all included the advice that cannabis
was the best treatment for migraine headaches.
If you are interested in reading more about migraines,
Ethan Russo, who was a neurologist in Missoula,
Montana, and is now the North American medical
director for GW Pharmaceuticals wrote a 60-page article
in the Journal of Cannabis Therapeutics
that explores the medicinal use of cannabis for the treatment
of migraines. He attempted for five years
to get government approval to do research on the use
of cannabis for migraines. And the government
refused to cooperate. Cannabis, of course, was in
the United States pharmacopoeia from 1854 until 1941.
Now, let's get on to modern research, because that's
what you are concerned about. Before the modern research, in
1937, at the Marijuana Tax Act hearing, Dr. William Woodward,
who was the chief lobbyist for the American Medical
Association, said that the AMA was strongly opposed
to this legislation and that the AMA knew of no dangers from
the medical use of cannabis. In 1949, there was a study done
showing that marijuana was useful in relieving seizures.
I have a number of patients who have seizures who get relief
from cannabis. One of those was a young woman
in her middle 30s, who had an AV malformation,
and had had a cerebral bleed, at the age of 17, and
another one at the age of 27. The same neurosurgeon
had saved her life twice. She was hemiparetic.
Her history was that she had recurrent, and unable to be
adequately treated seizures every day.
However, she said if she stayed just a little bit high
she never had a seizure. And many seizure patients have
found that if they are regularly using marijuana,
they don't have seizures. If for some reason their supply
of marijuana is interrupted they start having seizures
again. This is compatible with the
mechanism of action of cannabis, which I hope to have time
to get into later on. There were studies that were
done in the 1970s and 1980s in eight states, which
demonstrated that smoked cannabis was effective
in treating nausea and is an appetite stimulant.
In 1985, the federal government worked cooperatively with
Roxane Laboratories to get Marinol to the market.
They were concerned at the relatively large number of AIDS
patients who were gaining relief from marijuana.
And they wanted to have a pharmaceuticalized option.
Marinol is not marijuana. It's not pharmaceutical
marijuana. It is synthetic delta-9-THC.
Cannabis, as we will see later on, has 483 cannabinoids in it.
I'm the number one prescriber of Marinol in Santa Barbara County.
It does help some people. And it does not help
some people. In my clinical experience,
marijuana is preferable to Marinol,
but Marinol certainly does have clinical uses.
And those clinical uses go beyond the FDA approval.
And you know that you can prescribe drugs for off-label
indications as long as you have a defensible reason,
either from research or a strong anecdotal evidence,
to write prescriptions off-label.
As a matter of fact, 40% of all prescriptions are written
for off-label indications. The endocannabinoid system
is the largest neurotransmitter system in the brain.
We know practically nothing about it.
It was first characterized in 1992 by Raphael Mechoulam,
the Israeli scientist who isolated THC in 1964.
In 1999, GW Pharmaceutical, a phytochemical company,
that's a company that makes medications out of plants,
started doing research with a tincture of cannabis.
Their product is now being sold in Canada by Bayer.
In 2000, the California Marijuana Research Center
was started at the University of California-San Diego
School of Medicine. They have administered
in excess of 18 FDA approved smoke marijuana medical studies,
several of which have appeared in peer reviewed journals.
Dr. Donald Abrams is somebody who fought with the FDA
for nine years to get a study with smoke marijuana.
Finally, when he designed the study to determine
if it actually harmed people with AIDS.
They approved his study. He found out it not only
did not harm people with AIDS, but that it facilitated
weight gain. It was more effective
than Marinol, and of course more effective than the placebo.
Dr. Ware is at McGill in Canada.
And I always think it's ironic, I mean the Canadian border
is just less than 125 miles from where I grew up.
You can go to Canada and you can get legal marijuana,
you can get legal tincture of cannabis made
by GW Pharmaceuticals. Dr. Ware's area of interest
is relief of pain with cannabis and cannabinoids.
Dr. Donald Tashkin is a very good researcher at UCLA.
He is a pulmonologist. His research demonstrated that
cannabis was a bronchodilator. He also found in a study,
that I think he was surprised at the results, that
the incidence of lung cancer in people who smoke cannabis
was less than the incidence of lung cancer in people
who smoke nothing at all. And so it may actually be
a preventive in terms of cancer. There's a very good article
by Robert Melamed, who is a professor of biology
at the University of Colorado, Colorado Springs branch.
And Dr. Abrams had a recent article that appeared in
the Journal of Neurology in the February issue
showing that there was a 34% decrease in neuropathic pain
in people who had AIDS. For those of you who have
a real interest in learning more about this, there's a great
organization called Patients At A Time.
It's run by a nurse whose area of expertise is drug abuse
treatment, which is one of my areas of expertise.
They have put on conferences every other year since 2000,
including world class researchers.
Their upcoming one will have Abrams, Tashkin and Ware
presenting, as well as four of the five federally legal
medical marijuana patients. You may not be aware that
the federal government sends out 300 hand-rolled
marijuana cigarettes a month to four medical marijuana patients
and 300 every three weeks to a fifth.
Originally, there were 15 people in that program.
But several of them have passed away, because they
had significant illnesses. Anyway, I wish I had more time
to tell you about that conference.
Suffice to say I think it's worth your looking into.
Now, if I'm able to get you to think differently about
cannabis, it may have to do with the fact that
you are two generations younger than I.
It took me about 20 years from first finding out
about medicinal cannabis from my father,
who is a pharmacist up in Rice Lake.
We were talking about prohibition.
And he was telling me that when he was a freshman
in pharmacy school at the University of Minnesota in 1928,
that one of their assignments was to make tincture
of cannabis. It had nothing to do
with cannabis. It had to do
with making tinctures. How to extract the
pharmacologically active ingredient in plant material.
And he showed me this book, his 1927 edition of Remmington's
Textbook of Pharmacy. And on pages 999 and 1000,
it talks about cannabis. And it talks about the use
of cannabis as an anodyne, which is an archaic word
for pain killer. And that's still the number one
indication for the recommendation of cannabis,
whether it's in Oregon, Colorado, or California,
the three states that I'm somewhat familiar
with the statistics, somewhere between 60% and 65%
of the recommendations are for relief of pain.
And we'll get into that in a little bit greater detail
a little bit later. At any rate, it took me about
20 years before I finally got away from being influenced
by the propaganda that's out there.
That this was just a ruse to deal with recreational use
of cannabis. We need to separate
talking about the medicinal use of a substance versus the
recreational use of a substance. The fact that opiates,
and I have a long experience, 40 years of experience involved
in one way, shape or form, in drug abuse treatment prevention
with opiate abuse. And the fact that opiates
have some abuse potential does not stop us
from prescribing that for pain. As a matter of fact,
you have an organization here that started a support group
for people with pain. In California, there was
enough concern about physicians' lack of appreciation of treating
pain, that in order to have our license in California,
we must have 12 contact hours in end-of-life care
and pain management. We have developed, in this
country, an opiate phobia and often under-prescribe opiates.
I have a lot of experience, about 800 opiate abusers
that I've treated in my role as medical director of
a methadone maintenance program, an inpatient methadone
treatment program and an out-patient
opiate detoxification program. So I feel relatively comfortable
talking about that particular area.
In 2000, I started focusing on making recommendations for
the medicinal use of cannabis. I was comfortable with the fact
that it was medically useful, but I had an education
from my patients as to how useful it was.
And I'll give you a few examples as we go on with this talk.
Now, the AIDS patients were one of the first groups
of patients that started using cannabis to any great extent.
Of course, it was very helpful as an appetite stimulant.
Abrams' research later demonstrated that
in a double blind study. It's useful as an anti-nauseant
and as an anti-depressant. And Abrams once said that yes,
euphoria may be a side effect. But when you're treating people
with AIDS or you're treating oncology patients, a little
euphoria isn't a bad thing. And with cancer patients,
again, the anti-nausea, appetite stimulant
and antidepressant effect of the drug are very important.
Now these things are not only evidenced by the clinical
experience of myself and hundreds of other physicians.
As a matter of fact, in Oregon, where they have a mandatory
patient identification card program, 2500 physicians
have made recommendations to one or more
of their patients. So this isn't something
that is a marginalized group of weirdoes that are out there,
but are physicians who are listening to their patients.
And I can tell you that you have instant rapport
with your patients. Somebody comes in and tells you
"Doc, I'm a paraplegic. I have excruciating pain.
I was taking enormous amounts of oxycodone.
It was causing me to be confused.
It was giving me constipation. And I started using marijuana.
A friend of mine told me, try this.
And I tried it. I was able to dramatically
decrease the dose of Oxycontin that I was taking.
I was able to be focused. I wasn't confused.
I could play with my grandchildren..."
And you begin to appreciate the utility of this drug.
And also, when the patient tells you that
and you, as the physician, validate, yes this does have
pain relieving characteristics. This is something that I know
is helping you, you have really solidified the doctor/patient
relationship. You are hearing the patient.
You are listening to them. On the other hand, if you
roll your eyes skyward and say, "I don't want
to talk about that," that is going to have
a chilling effect on the doctor/patient relationship.
The use of cannabis as an anti-nauseant and
appetite stimulant and pain reliever are documented
by animal studies and culture studies.
I recently attended the 17th Neuropharmacological
Conference, October 31 to November 2,
where there were presentations
from all over the world, including two from the medical
college of Wisconsin. And these basic science studies
tend to complement our clinical experience.
These are, in my experience, the top six conditions
that cannabis is useful. Pain, of course, number one.
Sleep is something that is very effective.
And in many cases, it's to help treat insomnia
in people who have pain, nausea. Some people think that it has a
specific anti-arthritic effect. Interestingly, there are
a number of people with these arthritic conditions,
or autoimmune diseases, that we don't know much about
that it's good at relieving. I mean, fibromyalgia,
restless leg syndrome, complex regional pain syndrome.
Many people who have found no relief from anything else
find that they do get some relief, and in some cases,
a lot of relief from cannabis. I'm going to talk about ADD
and ADHD a little bit later. But it has a rather remarkable
effect on that. When I was at this conference,
I was sitting at a table with some of the honchos,
of course everybody there was a PhD.
And I was saying that I have a number of patients
that I've treated with cannabis for ADD and ADHD.
And they've said, you know, it helped me graduate
the Maritime Academy. And then I said there was
one of my patients who said it helped me
get my PhD. Well all of these PhDs
at the table laughed knowingly. Nobody there admitted
that it helped them get their PhD.
But they seemed to understand what I was getting at.
Okay, and of course the migraine headache thing.
This was something that Dr. Osler was right about then.
And he's still right. Other conditions,
seizures, glaucoma. The question of
how long it decreases your inner ocular pressure
is one that I haven't been able to nail down.
In discussions with just clinicians, some studies
indicate four hours. Other studies indicate
as much as 21 hours. It decreases your intra ocular
pressure by about 25%. So people begin to worry about
increased inner ocular pressure when it's at about 19.
And 25 is generally considered, if you're over that,
you absolutely have glaucoma. So let's say that your
inner ocular pressure was 22, and you could decrease it
by a fourth, you'd be down around 16 or 17,
into the safe range. So this is something
that is very helpful. Also people prefer
either eating, or tinctures, or smoking, or vaporizing,
as opposed to putting drops in their eyes.
So this is a reasonable alternative.
I mentioned the fibromyalgia, and that sort of thing.
Of course, diabetic peripheral neuropathy
is another kind of peripheral neuropathy,
just like the AIDS peripheral neuropathy.
I have several diabetic patients who have found that
this is the only thing that gives them relief.
We did a little study with Crohn's Disease.
We made a questionnaire and then sent it out
to several patients of Dr. Tod Mikuriya,
who recently passed away, but has given more
recommendations than any doctor in the United States.
At one time, he was in charge of marijuana research
for NIMH in the late '60s.
However, he thought he was there to do research
on the medicinal utility of cannabis,
and NIMH thought he was there to authorize research
on the dangers of the medicinal use
or the recreational use of cannabis.
So this was not a marriage made in heaven
and it didn't last very long. But at any rate, Dr. Mikuriya,
myself and Dr. Hergenrather sent out questionnaires
to our patients. And what we found was,
is that people were able to, who had Crohn's Disease
who were seeing us-- Granted this is a self-selected
patient population. Nevertheless, for them,
they were able to either dramatically decrease
their reliance on steroids, stop their steroid use entirely,
decrease or stop other medication used for
treating their Crohn's Disease. They had fewer stools.
They had more solid stools. They had less abdominal pain.
There is also animal research that backs up
this clinical experience. Depression is one of the top
reasons that patients give for using cannabis.
I had one patient who had something called
cyclical vomiting syndrome, which I had never heard of
until they came in. I now have, I think,
three patients with this. It's sometimes referred to
as migraines of the stomach. And it is unexplained
virulent vomiting. And this particular patient
was disturbed, because when he went into the emergency room
they looked at him as somebody who was an opiate-seeking
individual, and that this was self-induced vomiting.
He was treated punitively by the emergency room physician,
rather than as a patient. His cyclical vomiting syndrome
is almost completely relieved by his use of cannabis.
And I suspect this is because of the CB2 receptors in the gut,
and the fact that when they are simulated,
they slow down the speed of peristaltic contraction,
and therefore the speed of transmission of waste
through the gut allowing more time for water
to be extracted from the stool before it is released.
Okay, now the mental health diagnoses are probably
the most controversial. Nevertheless, there are
a number of patients who find relief from depression,
anxiety, stress, obsessive-compulsive disorder,
bipolar disorder. I don't know whether or not
you place Tourette's in a mental health issue,
but Tourette's. There's a researcher
at UC Irvine named Daniel Piomelli.
He was the chair of this Neuropharmacology Conference
in San Diego. He has invented a number
of pharmaceuticals that interfere with the metabolism
of the two naturally-occurring cannabinoids
that we've discovered so far. One is called anandimide
and the other is 2AG. And I've forgotten what the
2AG actually stands for. And he sees the endocannabinoid
system as being intimately involved in dealing with
attention deficit disorder, Tourette's, bipolar disorder,
panic attacks, and that sort of thing.
And that if you increase the amount
of the naturally-occurring cannabinoid, or if you take
an external cannabinoid, that you're going to benefit.
You're going to treat those conditions.
And certainly, clinically, this is what we found in California.
Now, let's see if I can find one other.
Something that you may want to purchase, or Google.
I don't know the URL, but there's a newsletter
called O'Shaughnessy's. It comes out about twice a year.
The editor of this used to be on the editorial board
of Scientific America. And he wrote the newsletter
for the UCSF medical complex. He's a very sophisticated writer
and very dogged and very diligent.
And this particular issue discusses the various conditions
that ten of the top cannabis-recommending physicians
in California, and I'm included in this,
have found. And this might be something
that'd be worth while to look at.
Also in the archives, there's a discussion
about PTSD, ADD and ADHD. I'm going to touch on those
briefly in terms of my take on why it works to help treat
those conditions. I just wanted to take a minute
to talk about a couple of clinical cases.
I already mentioned the first one with the person
with seizures. The second one was the woman
who saw me two weeks ago. A woman in her early 60s.
She has a 20-year history of daily migraine headaches.
She recently visited her 84-year-old aunt in Canada
and had a migraine headache. And the aunt said, "Here, have
one of these cookies." And she said she had no idea
that my aunt used marijuana. She didn't have the whole
cookie, she had a part of the cookie.
And she said that she didn't have a migraine headache
for two days after eating a part of one cookie.
She was in seeing me to get a recommendation
so she could use cannabis on a regular basis
and hopefully avoid her migraines entirely.
I had a patient who had back surgery.
He was a scuba diver. He asked his orthopedic surgeon,
can I go scuba diving? The orthopedic surgeon said yes.
I don't know anything about orthopedic surgery,
but I probably would have said yes, too.
He went scuba diving, something went dreadfully wrong.
And he became a quad for nine months, and then a para,
and had excruciating pain from T10 on down.
And he said that cannabis was the only thing
that prevented him from committing suicide.
I have any number of pain patients who find
that the use of cannabis has made their life tolerable.
Several of the federal medical marijuana patients
have made the point, "I didn't get this disease
so that I could legally use marijuana.
I would gladly stop using marijuana
if I didn't have this disease." Remember that when a patient
comes in and says this to you. Now, that doesn't mean
that if you are making recommendations for medical marijuana
that you should give them to everybody, that you
should hand them out like candy. In my office we screen people
on the phone. We want to know
what their diagnosis is. We want to know
what treatment they've gotten. We want to know what
the last time was that they saw a physician.
And if somebody calls up, we're three or four miles
from the University of California at Santa Barbara,
so if somebody calls up sounding for all the world like
a sophomore over there at UCSB, and they say, "I can't eat
and I can't sleep." Our next question usually is,
"Have you been worked up for this?"
Because we don't make an appointment for somebody
for sleep disorder unless they have had a work-up
at a sleep disorders clinic. So they usually say two things.
First they say, "No." And then they say,
"I don't believe in doctors." We don't make an appointment
to see that person, because we don't think that they meet
a reasonable criteria for having a recommendation
for medical marijuana. There's no sense
for having them come in and waste my time, and me
to waste their time and money and for them to go away angry.
Better that we say no, we're not going to make
an appointment for you. Now on PTSD, this is
probably one of the most important reasons
for you to be here today. We know that 30% of the people
coming back from Iraq, at least, are going to have
post traumatic stress disorder. And I can tell you from seeing
patients from the Vietnam era, the first war in Iraq
and this war in Iraq, that this is
a very serious condition. People are hyper alert.
They're startled. They have nightmares.
They have anger. And we, the American people,
have put them in harm's way. And by under-funding
the Veterans Administration, we have not adequately
dealt with them. Furthermore, the federal
government has prevented the Veterans Administration from
being able to recommend cannabis for the treatment of PTSD.
Now, we have a VA clinic in our community.
They refer patients to me. The husband of our mayor
is a doctor. He works at the VA clinic.
A year or so ago, we were walking through a restaurant
and they were having supper there with their son.
He called me over so he could introduce me to his son,
and say this is one of the top marijuana-recommending doctors
in California. He has suggested to some
of his patients that maybe if they saw Dr. Bearman,
he might recommend cannabis for the treatment of PTSD.
One of the founders of Patients At A Time,
and there's some flyers up here for that conference,
is Al Burn, who's a retired Lieutenant Commander in the Navy
who has PTSD. This patient here lives in
Bishop, California, which is just about 10 miles
past the end of the earth. He lives 20 miles outside
of town at the end of the road at the last house.
And he says, "I try to avoid going into town altogether,
and not more than once a month, because I can't stand
being around people. And if it wasn't for marijuana,
I'd start killing people." There's a lot of people
that have been traumatized as a result of war.
And there are other people who have been traumatized
as a result of rape, or kidnapping,
or growing up in a dysfunctional family
where they've been physically or sexually abused.
And cannabis is useful in relieving some
of those conditions. ADD, ADHD, I told you
the story about the PhD guy. Crohn's Disease,
I've mentioned that. In terms of pain management,
people tell me, "When I started using cannabis,
I was able to either A, stop using the opiates
that I was using, or decrease them by 50% to 66%."
It has fewer side effects than opiates.
And this is for the patients that I'm seeing.
Again these are self-selected patients, so I'm not saying that
this is a universal situation. Nevertheless, there are
all kinds of studies, and studies with mice
who presumably have no political agenda
showing that they are able to deal with hot plates,
in terms of tail flick, or whatever other kinds of things
that they are studying. In 1997, there were seven
such studies that were presented before a neurology conference
that was held in New Orleans. And it was front page story
in the LA Times , and that's how I became aware of it.
But these studies were done at such radical places
as the University of Minnesota, Wake Forest,
University of Texas, and that sort of thing.
In addition, there were discussions of pain
at this recent conference that I came back from
in San Diego. Since cannabis is useful
in treating abdominal problems, there's little
or no abdominal pain. There's no nausea.
We know that with morphine, something like 22% of people
who you give morphine to are going to have nausea
and vomiting. There's less confusion
and dizziness. They're able to drive.
They're able to play with their children
and their grandchildren. This decreases their perception
of pain in some instances. In other instances
it allows them to concentrate on other things
rather than their pain. As I mentioned, it decreases
their reliance on opiates. Suffice to say
that you have pros and cons, but you have
the former surgeon general, you have the editor
of the New England Journal of Medicine.
And most importantly, you have the 1999 government commission,
government paid-for Institute of Medicine report
that says marijuana is medicine. They do take some dispute
with smoking as a mechanism of action.
But fortunately, there are a number of other mechanisms
of action. In terms of safety,
every western government study ever done
has recommended the legalization of recreational use of cannabis.
So one would think that the medical use might be safe.
There was a two-year hearing presided over by the chief
FDA Administrative Law Judge, Francis Young.
And in his findings of fact, he said that cannabis
was one of the safest therapeutic agents known to man.
That's the FDA's chief Administrative Law Judge
telling you that, not Dr. Bearman.
Marinol, which has more side effects than cannabis,
because it does not have the mitigating cannabinoids
in it that cannabis does, has been approved by the
Food and Drug Administration. It's one of the few,
if not the only drug, that has been upgraded
from a Schedule II drug to a Schedule III drug.
And Sativex has been approved for research
in England and Spain. And it has been approved
for sale, and has been sold in Canada by Bayer since 2005.
In December of 2005, the U.S. Food and Drug Administration
approved a Phase Three, as you know that's with people,
clinical trial to determine whether or not
tincture of cannabis-- And you know, tincture of
cannabis is made by putting the flowering tops of plants
in alcohol, leaving them there
for a couple of days, straining off the plant material
and left with the alcohol infused with the cannabinoids
and some of the phenoids and flavonoids
that are in the plant that have the therapeutic value.
And that has been approved by the Food and Drug
Administration for the Phase Three clinical trial.
They just started that in July of this year.
But I have every reason to believe that Sativex will be
available in this country in four or five years
depending upon how fast or slow the FDA process moves.
Okay, we know that it's efficacious.
I'm not going to go into this. Now, in California we had
a number of laws and court decisions
that sort of clarify things. Basically, it is legal for me
to recommend cannabis. It's legal for me to talk
to patients about cannabis. The federal government
was enjoined from harassing or intimidating physicians
from giving medical advice, including medical advice
about cannabis. I mean, what the federal
government wanted is, if you're patients asks you,
"Doc, do you think that cannabis is good for me?"
that we should say, "I can't answer that,"
or "Well, I don't know," or something like that,
rather than what we did know. If you think that it's not good
for them, say so. If you think that it is, say so.
The Ninth Circuit Court of Appeals
has a permanent injunction against the federal government
that prevents them from interfering with doctors
and exercising our right of free speech,
and our patients, from interacting with us and
asking us any medical question that they want,
including do you think that cannabis is a medicine
that might be useful for me? And you need to form your
own opinion as to whether or not you think it is.
But you really have an obligation to your patient
to give them a straight answer. And you have to be careful
so that you are not influenced by the hysteria that has been
abroad in our culture for years and years,
and that you base your decision on the training
that you're receiving here at the University of Wisconsin,
and the additional training that you'll receive when
you go to clinical conferences, so that people are actually
talking about facts rather than about emotion and hysteria.
Okay, I'm going to-- Bearman v. the Los Angeles
County Superior Court was a case involving me.
The Medical Board in California has a poor reputation
amongst physicians that long precedes
the re-legalization of medical marijuana.
They wanted to subpoena a patient's records over the
patient's refusal to waive their right to privacy.
They found a very pro-government superior court judge
who granted the subpoena. We appealed
to the appellate court. We got a 3-0 decision
in our favor. The reasoning in the decision
was stronger than if I had written it myself.
They said the Medical Board, that they had no complaint.
Their job was a investigate complaints.
They had no complaint about me. What they had was a letter
from a forest ranger saying, "Is this ethical?
Is this legal? Do doctors
know what they're doing?" Do doctors
know what they're doing? Yes, I think we do.
Okay. We are now suing
the Medical Board of California a second time to get the money
it cost to sue them the first time,
since they had no right to come after the records
in the first place. Oh, by the way, because
we appealed the case, they were trying to fine me
$1,000 a day for each day that
I didn't turn the records over. And my fine
would have been $115,000 if I had lost the case.
In the appeal, I had an Amicus Brief
from the California Medical Association.
These things are important. You need to understand
what your responsibilities are as a physician.
And protecting the sanctity of the doctor/patient relationship
is one of your responsibilities as a physician,
having nothing whatsoever to do with whether or not
you ever make a recommendation for the medicinal use
of cannabis. Okay, so let's talk about
what the Medical Board guidelines are.
They don't sound bad, but the fact of the matter is
that they're moving a target and the Medical Board sort of
makes them up as they go along. We need to do a good faith
history and physical. The patients needs to be
a bona fide patient. We need to review their records.
And we need to have a plan. Now, unfortunately,
there are some doctors that are running mills out there.
What we refer to as HMO-style medicine, and we don't think
that that's right. We're trying to marginalize them
by forming an organization called the American Academy
of Cannabinoid Medicine. And we hope to have that off the
ground by the first of the year. Okay, my criteria is this.
It's is hypothetical. If we hypothetically assume
that the Medical Board of California is reasonable,
which is quite a reach, and we further assume
that they had the power and authority and ability
to randomly select any one of my patients
to say, "Dr. Bearman would you explain to us why
you made this recommendation?" that I'd be able to do
so in a manner in which they'd be able to understand.
I got into this, because I do expert witness work
on recreational drugs, and have since 1972.
Most of those drugs, most of those cases, more than
300 where I've testified at trial, have not been
marijuana cases, but 30 or 40 of them were.
So, I'm always thinking in terms what is the attorney on
the other side going to ask me? And that's the way
that I approach the history with the patient.
I want to be able to be on solid clinical grounds
when I make the recommendation for the medical use
of cannabis. As I mentioned,
we screen people on the phone. We want them
to bring in their old records. If they don't bring in
their old records, we'll do a history and physical.
And if they qualify, we'll say we will give you
a recommendation as soon as we get your confirming
medical records. I spend 45 to 60 minutes
with a new patient. Do all of these things there.
I want to spend about two or three minutes here
and then give you about six or seven minutes
for questions. 483 chemicals in cannabis.
Some people say well, you know, these plants, these herbs,
they're complicated. We don't understand them.
True enough. And that's one of the things
that took me 20 years to sort of accept this.
That manufactured medications are modern.
We know all about them, we think.
Our experience with manufactured medications
go back to just before 1900. Aspirin
being the first synthetic. Our experience with herbs
and plants go back, what a few thousand years?
A few million years? We have quite a bit
of experience with them. And we shouldn't--
apriority assume that manufactured pharmaceuticals
are somehow superior to plants. And in fact, there are
certain branches of medicine that are going into the Amazon,
that are a talking to Shamans, that are taking a look
at these various medications. Okay.
The endocannabinoid system, as I said, is the largest
neurotransmitter system in the brain.
We don't really understand it. It tends to moderate
sensory input. And I think this is
the important thing. I'm going to kind of end
talking about this and then just slip through
the rest of the slides and let you read them.
The way that I believe that it works
is in freeing up dopamine that is trapped
in dopamine transporter. For some reason,
there's an excessive amount of dopamine transporter
in a number of these conditions. And so, we don't have
enough dopamine. And what the endocannabinoid
system is important for doing is when it's released
and stimulates the next neuron on the other side
of the synapse, it causes dopamine
to come back to the neuron that just released,
that just stimulated the next neuron.
It depolarizes it and it makes it more difficult
for that neuron to be stimulated by the next neural impulse
coming along. Recognize that this is why
clinical impression of what's going's on
from people that have done basic research.
I'm sure that to the extent that I'm wrong, Dr. Kozee
will educate me after this. When I explain to my patients
that I think that this is what is going on,
they say, "Yeah, that is. I'm able to focus.
I'm able to concentrate. My attention deficit disorder
goes away or my depression
gets much, much less." Okay, so this is that schematic
that your familiar with. But basically, the concept
that you need to keep in mind is the concept
of retrograde inhibition, and that the post-synaptic neuron
is going back and affecting the pre-synaptic neuron,
so that the next neural impulse coming along
will have a harder time stimulating that.
And so we're having fewer, slower moving neural impulses
to the midbrain, the reptilian brain.
So people who have problems with anger associated with PTSD,
instead of having the amygdala, the rage center, overpowered,
and by rapidly moving anger impulses,
you have the same anger impulses,
but fewer. And the neocortex
has an opportunity to say, "Don't call that person an SOB,
they're likely to get angry," and so you don't.
And you have a different outcome of that interaction
than if you called him some dirty so and so.
Okay, let's just kind of flip through these
and see what we have. This says, in words, what
I've been trying to convey. This talks about
cannabinoids and PTSD. This, again,
says the same thing over again about enhancing the retrograde
inhibition. Decreasing the sensory input.
This is talking about the dopaminergic system.
Talking about its involvement in
the attention deficit disorder. This, again, talks about this,
and, you know, this is getting into
the basic science stuff where my eyes
begin to glaze over. These are some actual quotes.
The second quote came from when I was being interviewed
by a reporter for USA Today on the use of marijuana
for migraine. This was after
Kareem Abdul-Jabbar had been arrested.
He had gotten a recommendation from a physician whose practice
I was sitting in on while he was out of country.
I was talking to this reporter, and she was regaling me
with her experiences with recreational use
of marijuana in college. And after about 20 minutes
of sort of chuckling and laughter,
the waitress came over and told us about the benefits
her son had gotten. This was a completely
unsolicited comment. And of course, you don't
have to smoke marijuana. You can vaporize it.
It has 70% fewer irritants than smoking it.
You can use it sublingually, as the Sativex is.
You can take it orally. The Sativex is a spray.
It's in a metered sprayer. The Sativex people want to get
this approved by regulators. They don't want it to be abused.
That's why it's in a metered sprayer.
It's a combination of 50% from a whole plant extract
high in THC and another whole plant extract
high in CBD. The THC
for the therapeutic value, the CBD because it tends
to dampen down the euphoria. Marinol is an oral route
of administration. A little bit different
when you eat marijuana than when you smoke it,
because 85% of it is metabolized on the first pass
through the liver. What does that mean?
I don't know. It means that your getting
different chemicals. We have not studied this enough
to know if it has any significance,
or whether or not there are certain conditions
that are going to respond better to the respiratory route
of administration than the oral route.
The respiratory route does allow you
to titrate the dose. Its onset of action is going
to be in 15 to 30 seconds. The sublingual onset
is going to be in 15 minutes. And the oral onset is going
to be 45 minutes to an hour. Recent developments.
The chief Administrative Law Judge of the DEA
ruled in a case involving the University of Massachusetts
that the DEA should sell a license to grow marijuana
to this professor of botany who's an expert in medicinal
plants, so that he can study the various constituent
components of different strains to determine which
of the chemicals or combination of chemicals
are best suited for the various conditions that
I've been telling you about. Of course I mentioned
the Journal of Neurology article by Dr. Abrams
and the FDA Phase III study. Where are we at now?
Lester Greenspoon, who wrote, Marijuana
the Forbidden Medicine, is saying we're at the juncture
as to whether or not we're going to have
pharmaceuticalization, or whether or not individuals
are going to be allowed to treat themselves.
In other words, will the traditional American
rugged individualism prevail or will the corporations
dominate? Dr. William Woodward,
I mentioned, said that the AMA knows of no dangers
from the use of cannabis in the 1937
Marijuana Tax Act hearings. Dr. Joycelyn Elders,
former U.S. Surgeon General, has come out in favor
of medicinal cannabis. This is what
Judge Francis Young said. I mentioned him talking about
the safety of cannabis. Rodney Dangerfield
wrote a book called, It Ain't Easy Being Me.
In that book he has a picture, it's not quite that one,
and it says, "Here I am looking at the best piece of mail
I ever got." And the rest of the caption
is, "A letter from Dr. Bearman telling me to smoke more pot."
Now, I didn't tell him to smoke more pot.
I told him that I approved of his use of cannabis.
And his wife spoke at the Patients At A Time conference
we had in Santa Barbara. And I couldn't believe this.
She said that after he got this, because he seemed somewhat
disinterested, like he was sort of mollifying his wife,
he showed his letter to everybody.
And when he passed away, she put his letter in his casket.
So we know that Rodney will not get arrested
up in heaven, or wherever
he's telling his jokes. And I'm going to stop with that.