03/24/13 Jeff Hergenrather

Dr. Jeff Hergenrather on cannabis use for irritable bowels, Mimi Friedman of Colo Patients group & Dr. David Bearman a CA medical cannabis doctor

Program: 
Century of Lies
Date: 
Sunday, March 24, 2013
Guest: 
Jeff Hergenrather
Organization: 
Doctor
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Transcript

Century of Lies / March 24, 2013

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DEAN BECKER: The failure of Drug War is glaringly obvious to judges, cops, wardens, prosecutors and millions more. Now calling for decriminalization, legalization, the end of prohibition. Let us investigate the Century of Lies.

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DEAN BECKER: Welcome to this edition of Century of Lies. I was quite surprised to find the missing disks so we have another show for you from Americans for Safe Access conference out of Washington, D.C. This is Dr. Jeff Hergenrather.

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JEFF HERGENRATHER: Hi, my name is Jeff Hergenrather. I’m a physician in Sebastapol, California. I’ve been practicing cannabis medicine for about 15 years.

My training started at Brown University back in 1970. I was in the first graduating class of the Brown Medical School in 1975. I began studying cannabis really at the university with interest in cannabinoid science which wasn’t called that at the time. It was just science of cannabis. I found the polarization was dramatic even back in the early 70s at about the time the Controlled Substance Act passed.

What I went on to do is finish a residency as a rotating intern and went to work in general practice. Soon after my wife and I went to Tennessee were we joined a community, an intentional community known as “the farm.”

At the farm cannabis was looked upon as a sacrament and it was used by adults for spiritual reasons and for medical reasons. I, as the doctor in the community, was in a unique situation where patients were coming to me and describing all the benefits that they were getting from cannabis use. I had no idea of the science at the time. This is before the endocannabinoid system was discovered beginning more in the 90s.

In the 70s and the 80s I was on the receiving end of patients talking about it helping with mood disorders, anxiety, depression and PTSD, all kinds of pain syndrome from neuropathic pain problems to endometriosis to acute pain, chronic pain of all kinds. Really a laundry list of medical diagnosis that were benefiting with cannabis use which included autoimmune diseases, rheumatoid arthritis – just a variety of conditions – epilepsy….people were describing many benefits of cannabis that I didn’t understand but I was, as a physician, listening to their stories and appreciating that they were really benefiting with the use.

From there I moved on to California with my family in the early 80s and it wasn’t until 96 that California passed the Compassionate Use Act of 1996 making cannabis legal within the state of California for Californians who had a serious medical problem if approved by their physician. I became one of those docs really at the time that the law changed and then building up a practice privately until 1999 when I rented office space and started really in earnest in a cannabis consultation practice. I’ve been doing that since then.

I have an unique practice that I spend a lot of time with patients – really take them on as my own patients. I council them about their health in many ways which often includes counseling them about diet and hypertension and diabetes and all kinds of medical conditions – not to mention the presenting problem for which I’m seeing them for.

There’s this vast array of diagnosis that I’m seeing from things as obscure as organ transplants where the immune system is down regulated by cannabis and helps the patients keep their organs to chronic pain which is the biggest single group of patience and then, again, as I started speaking of earlier just a host of different medical conditions for which cannabis provides relief by way of all the pharmacologic actions of the endocannabinoid system.

It was the year 2000 that Dr. Tod Mikuriya gave me a call and asked if I would join a group of docs round table and come in and talk about our experiences. Dr. Mikuriya had a significant past history at working at NIMH and really rediscovering the medical uses of cannabis from William O’Shaugnessey’s in the 1800 up until cannabis was outlawed in the United States in the 1937. He put together a book of the English literature of the medical conditions for which cannabis was being used.

Tod came to our group and asked us to sit down and talk about the things that we were finding with our patients. One of the first things that we noted among our group of doctors is that a lot of people found relief with Crohn’s disease. I found that very interesting…

Crohn’s disease was very interesting to me because as a medical student my first surgical case was a woman with Chron’s disease who was doing very badly. In her early 30s had multiple surgeries and, unfortunately, was not doing well at all.

It impressed me that we didn’t have a lot to offer to this condition. As patients were coming in and saying, “Doc, cannabis is curing…or not curing but alleviating my symptoms of Chron’s disease.” That really caught my attention.

We decided to, as a group, to study the use of cannabis by these patients and I was charged with the responsibility of developing a questionnaire that we could share among the docs, take this back to our patients and then ask them what was the relief that they were getting. We as a number of questions of them as to stools per day, how much pain they had, what their activity level was, what their weight was and so forth with and without cannabis.

In asking the question in both ways you get what is called a two-tailed t-test meaning each patient is logging in for with use and without use of cannabis on all of the questions that we asked them. We found some really profound results. There was about a one-third decrease in the number of stools per day. There was about a 12% weight gain among the patients and pretty much uniformly patients were benefiting with a marked degree of pain relief, much more appetite, much less nausea, much less vomiting, activity level was up, fatigue was down, the flare up frequency and the flare up severity were both markedly down regulated. We just saw across the board benefits.

Years later we began to find where the endocannabinoid system resided in the GI tract and we saw that there were these CB1 receptors not only in the dorsal aspect of the brain stem but on out through the vagus nerve into the bowel wall where the nerve plexuses in the bowel wall, the excitatory nerve endings in the bowel and all the way into the mucosa of the bowel are all endowed with CB1 receptors and CB2 receptors.

We felt that we really had some confirmation of some evidence as to why cannabis was working. We went on to find that the experimental science showed that cannabis was down regulating the amount of contractility in the gut, the motility was slowed down, the secretions were diminished and it made sense that the patients were describing fewer stools, less pain and for a Chron’s patient this is life changing because Chron’s is a disease where patients are looking for the next bathroom even to leave the home. When they are more comfortable, have less cramping and stools it really changes their lives.

We put our data together and I began to report on it in a preliminary report to the International Association for Cannabinoid Medicine in 2005. We finished up the study a couple years ago and I reported on it yesterday at the ASA meeting…actually it was at the Cannabis in Medicine Conference put on by the Canadian Consortium for Investigation of the Cannabinoids along with a physician group that I chair called the Society of Cannabis Clinicians.

DEAN BECKER: Let me ask you a question. That’s one example of how it benefits Chron’s patients. We have those in government, those in positions of authority who say there’s not enough study, there’s not enough evidence. They discount this information. I think, in many cases, they refuse to read or investigate or acknowledge. Your response to that…

JEFF HERGENRATHER: Follow the money. It is as simple as that. We have vested interests in keeping the drug war going. The drug war I’m speaking of broadly to include our court system, law enforcement in general all the way from the federal level to the city police departments, the incarceration industry, the pharmaceutical industry, alcohol and tobacco – the list is long. When you really look at all of these as an aggregate of vested interested parties in keeping things as they are we’re not going to see a change coming by showing more evidence. There is a lot of evidence both experimental and in human studies to show all of the benefits of cannabis that we’re appreciating. There’s a vast amount of information. If you look at the citations in the literature it’s phenomenal how much information is out there.

So to call it a lack of studies is really disingenuous. It’s really not true. There is a lot of information out there - certainly comparing to other common medicines. Look at aspirin, tobacco, alcohol in our society – huge loss of life from those substances and cannabis does not cause that. We’re not going to see our government just turn over and say, “Oh, you’re right.”

That’s not going to happen. We just have to keep picking away until each state that changes the law and decides that we should legalize cannabis medically or even for adult use is going to gradually tip the scales until I think we’ll get to a point where the legislature in the U.S. government will have to say, “OK, let’s change the Controlled Substances Act and take cannabis off of Schedule I and put it where it rightly deserves to be as an herb.”

I’m a strong proponent of seeing cannabis available to people to grow in their yards for their own personal medicine.

DEAN BECKER: I think we’ll just leave it right there. Is there a website, some closing thoughts.

JEFF HERGENRATHER: I would like to point out our website. Our physician group is called the Society of Cannabis Clinicians. We started out under Dr. Mikuriya’s founding of the 501 c(3) as the California Cannabis Research Medical Group and because we wanted to have a reach further than just California we changed our name to the Society of Cannabis Clinicians and you’ll find our website at http://cannabisclinicians.org.

It’s a very useful website. We’re finding docs signing in from all over the nation thanking us for putting up this information. They can share their case reports on the website. People can check in and see what kind of conditions are being treated with cannabis and some of those stories. We’re also keeping up with the basic science on the webpage so people can see what’s going on as well as meetings that are happening around the world in cannabis science.

We enjoy people signing in to the website. What we’re finding is that we’re getting numerous comments from people around the country – many of whom are in Texas where cannabis is forbidden – are writing us with stories of their cancer and other medical conditions begging for support because they just can’t find out enough. Many people are saying, “I’m ready to move to Colorado or wherever in order to have access to cannabis.”

So we do the best we can to support all these patients by directing them not to the medicine itself but to information so they can understand why cannabis may benefit them in their illnesses.

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MIMI FRIEDMAN: Hi my name is Mimi Friedman. I volunteer for a lot of different patient organizations like C4CPR which Coloradans for Patient Rights. I also work for NORML. I’m on the board of directors for Cleveland NORML. I’m from Ohio – that’s my home state. I’m their patient advocate. I just kind of do patient advocacy stuff.

I have end-stage achalasia with full esophageal muscle spasms, gastroparesis, peptic ulcer disease, a sliding hiatal hernia, postural orthostatic syndrome and multiple spinal and skeletal injuries from car accidents.

Cannabis has helped me. My secret, I guess, is vaporizing pure Indica hash like butane hash oil or the wax or bubble hash works just fine as long as it’s pure Indica. If I have a constant, steady supply of that in my system I can eat and drink normally which is amazing for me because my condition causes you to vomit continuously and it causes you to not be able to keep any food or drink down.

I had a feeding tube until about two months ago and I moved to Colorado. Since being in Colorado my feeding tube has been removed. I’m healthy enough to work again for the first time really since my first car accident which was New Year’s Eve of 2002.

My team at the Cleveland Clinic has always been very supportive. I’ve always been very open about my cannabis use with them and they understand that it’s helping me. They can’t specifically condone illegal activity. It’s not legal in Ohio yet. Ohio does not have a medical program so it makes it very difficult for patients who are using cannabis even if their doctors approve of it to continue using it because people don’t want to take the risk to grow so any home grown medicine in Ohio costs about $400 to $450 an ounce. Obviously for a patient with no job that’s not a feasible living situation.

Cannabis laws are really the only things that drove me out of Ohio. It was me not being able to stay there because I was going to die. The Cleveland Clinic was telling me that my only option was open digestive tract reconstruction surgery which would include getting my esophagus completely removed, having my stomach pulled up to make a new esophagus which they weren’t sure would work because my stomach is damaged too from the esophageal paresis.

These were shots in the dark pretty much. My medical team tried as hard as they could to help me but without having access to cannabis and without being able to treat patients with cannabis they can only do so much. Western medicine only goes so far.

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DAVE BEARMAN: I’m Dr. Dave Bearman. I’m a physician in Goleta, California. I do pain management. I’m one of the founders of the American Academy of Cannabinoid Medicine. The academy is interested in marginalizing those doctors who are practicing minimalist medicine that recommend cannabis. The reason that we do this is we are serious physicians and we think that health care professionals and the general public need to take the health benefits of cannabis very seriously.

This is an amazing medication. Certainly it can be used recreationally but that’s not what I’m talking about. I make an effort to screen my patients so that the people that I see are pretty ill. I have people with failed back surgery, cancer, paraplegic, quadriplegic. You have to have a legitimate medical reason in order to even get an appointment to come in and see me.

The neat thing about the use of cannabis to treat pain, for instance, is that it has far fewer side effects than opiates do. As a matter of fact in 1988 the DEA Administrator Judge, Francis Young, said after a 2 year hearing to reschedule cannabis as finding of fact that cannabis was one of the safest therapeutic agents known to man.

As a physician doing pain management who prescribes opiates I’m relieved when I can see a patient who is able to either stop using opiates entirely or to decrease their use of opiates because they are now using cannabis.

Cannabis is an incredible analgesic. It’s been around for 5,000 years. If you take a look in any material medica that’s ever been printed in the last 2 or 3,000 years you’ll see that people have traditionally used this as an analgesic.

The other thing that I’m really impressed with is it supports our returning veterans, our men and women who fought in Iraq and Afghanistan as well as Viet Nam who have Post-traumatic Stress Disorder. Cannabis is able to take care of their anxiety, their depression, being quick to anger. It can decrease their being hyper-alert and their easy startled. Again, it has very few side effects.

Many people with PTSD are being treated with some kind of stew or goulash, if you will, of a variety of medications that have significant side effects. Again, the side effects from cannabis are minimal. If you don’t smoke it the main side effects would be a little euphoria and as Dr. Donald Abrams from UCSF who is an oncologist (a cancer physician) says, “Look, in my patient population a little euphoria isn’t a bad thing.”

It’s been very rewarding to be in the medicinal cannabis arena because there is so much to learn about the way the body operates. We’ve learned an awful lot about what we call the endocannabinoid system. Cannabis doesn’t work by magic. It works by in some cases stimulating cannabinoid receptors and in some blocking cannabinoid receptors - the same way our own marijuana-like chemicals that we produce in our own bodies every day act.

Some of us are suffering from an endocannabinoid deficiency. Just like anything else the level of cannabinoids 2-AG or the anandamide is arranged in a bell shaped curve – some of us have more, some of us have less. Those that have less are more likely to suffer from Attention Deficit Disorder. We may have migraines. We may have seizure disorders. All of those conditions are benefitted by the use of cannabis.

As a matter of fact the first modern research that was done on cannabis was done in 1949 where 7 people who had intractable seizures were treated with cannabis and 5 of them either had no seizures anymore or had very few seizures. This is a remarkable substance and I’m happy to know a little bit about it and happy to be able to talk to people about it. We need to dispel so much information and fear that is out there which is not based on science. It is based on politicians and you know what they say, “Do you know how to tell if a politician is lying? When their lips are moving.”

So be very careful about the information that you take on this. Another group of people who has a lot of disinformation are the police because this will ruin their business. Remember we got along without cannabis being illegal for a long, long time in this country. As a matter of fact it was in the United States pharmacopeia from 1854 through 1941. In 1937 in regards to the Marihuana Tax Act the American Medical Association strongly testified against the Marihuana Tax Act.

The AMA recently in 2009 came out for rescheduling cannabis. It is long past time that we did that. We need to avoid this tag team of the DEA and the National Institute of Drug Abuse (NIDA) blocking legitimate research. On the one hand the government says you need more research and on the other hand they block the research.

What this has done is this has caused the cannabinoid and cannabis-based pharmaceutical industry to go away from the United States. GW Pharmaceuticals, which is a British company, makes Sativex which is essentially liquid marijuana – a tincture of cannabis. Who distributes it? In Europe it is distributed by Alamar, a Spanish pharmaceutical company. In Canada and the United Kingdom it is distributed by Bayer, a German company. The rights for much of the rest of the world Asia and Africa and Australia are held by a Swiss company and the rights for the United States are held by a large Japanese pharmaceutical company called Odsaka.

These pharmaceutical companies are doing this because they know that cannabis is medicine. They know that it has wide applications for an incredible number of conditions. The reason for this is because of the endocannabinoid system. The endocannabinoid system is composed, so far as we know, of 2 different cannabinoid receptors called CB1 and CB2. There are three other receptors that the cannabinoids attach to. These receptor sites are located in the brain and throughout the body. They are not located in the brain stem which is why no one has ever died from an overdose of marijuana.

You would have to consume 1,500 pounds in 15 minutes in order to get an overdose of marijuana – good luck. Occasionally there are side effects from using cannabis although I must say more often these side effects occur with Marinol which synthetic THC. Cannabis, of course, is 483 compounds in it including CBD, cannabidiol, which tends to decrease the euphoria that can be caused by THC.

Some people do get concerned about having an excessive amount of euphoria which is called dysphoria. While panic attacks have been reported from cannabis use particularly from naïve users who get rather high doses I don’t recall seeing that in one of my patients although it may be that one or two of them reported it and I just don’t recall that.

Other than that cough is one thing that can happen from smoking cannabis and the best way to deal with that is to switch to a vaporizer or to a liquid. There’s a real misconception out there that the only way to consume cannabis is by smoking it.

Now the respiratory round administration does have certain advantages but if you want to take advantage of those advantages you can vaporize which means heating the plant material to a point in which you release the oil but not to the point where you ignite it. You have about 70% fewer irritants and therefor you have a lot cough with vaporization than you would with smoking.

I want to criticize the medical schools for not teaching about the endocannabinoid system which, as I just said, is the largest neurotransmitter system in the body. I mean there is no excuse for doctors not being aware of that. Now if they want to learn more there are a number of places that they can look. One of the places where they can get very current information is in this publication, O’Shaughnessey’s, that is put out by the Society of Cannabis Clinicians.

I’d also like to push my books, “Demons, Discrimination and Dollars: A brief history of the origins of American drug policy” which talks about some of the reasons that we have the crazy laws that we do. I want to alert people to the fact that my new book, “Not the Devil’s Tools” will be coming out. It has 5 or 6 chapters on medicinal cannabis. It also talks about why we have the strange policies that we do and gives some suggestions about policies that we can have.

What O’Shaughnessey’s does is it tends to synopsize research that is presented at scientific conferences. What people don’t realize is there is over 20,000 research studies that have been done over the past 20 years regarding cannabis and cannabinoids and its effects on human beings. Many of those are related to what its therapeutic effects might be.

The American Academy of Cannabinoid website is http://aacmsite.org or they can also go to my website http://davidbearmanmd.com

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DEAN BECKER: Well that’s it for this show. Please do your part to end this madness. Prohibido istac evilesco!

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For the Drug Truth Network, this is Dean Becker asking you to examine our policy of Drug Prohibition.

The Century of Lies.

This show produced at the Pacifica studios of KPFT, Houston.

Transcript provided by: Jo-D Harrison of www.DrugSense.org