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: Hi, this is Dean Becker, your host on Century of Lies. Thank you for being with us. The first segment we have today was recorded last week in New York where the New Physicians for Compassionate Care (some 600) strong held a press conference. This is part of that conference.
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HOWARD GROSSMAN: My name is Howard Grossman. I am an internist in private practice in New York. My specialties are primary care, lesbian/gay/bisexual/transgender medicine and HIV medicine.
I am the chair of a group called New York Physicians for Compassionate Care that is supporting the passage of the Compassionate Care in Albany that would allow doctors to talk about and prescribe the medical use of marijuana and cannabinoids.
We have a very distinguished group on the call that I will introduce – all physicians: Dr. Sunil Aggarwal, Dr. Julie Holland, Dr. Matthew Jackson (who will be joining us shortly), Dr. Mark Pettus, Dr. Craig Blenderman - all on the call who will speak to various issues regarding the medical use of marijuana.
We are going to follow that up with a question and answer session and we are going to try to give the most time to that so we’re going to keep our speakers to a very tight schedule and short statements.
All the doctors will be available for interviews following the conference. We want to use this call to announce the formation of New York Physicians for Compassionate Care.
Dr. Blenderman was the author of a letter that reached out to physicians asking them to support the Compassionate Care Act and to support the medical use of marijuana and there was a huge response – 730 responders from health care practitioners, 600 of them were from across the state of New York – up state, down state, mid-state you name it we have physicians who came out in support of this bill and of the use of medical marijuana.
We are also glad that there is support from the New York State Nurse Association, the Pharmacist Society in the State of New York. We’re here to speak on behalf of physicians because physicians voices have not really been heard that much in this debate.
Our biggest issue here is one of compassion. We are calling for compassion for our patients and compassion for doctors who wish to talk about a useful and safe medication for use in people with serious illness.
The New York State proposal is one of the most tightly regulated proposal in the country. There are, at this time, 18 states and the District of Columbia that allow the medical use of marijuana. The New York statute is designed to work off the strengths of those other states’ experiences as well as to deal with some of the weaknesses that have been shown in some of those other states in the way that they’ve rolled things out.
This is really an amazing accomplishment. This bill strikes a balance between ensuring patient access , preventing diversion and giving the doctor the opportunity to talk to patients, recommend medical marijuana for those patients with serious or debilitating conditions that might benefit from it.
As physicians we always start from the science and that is a very important component for us. I’m going to turn this over now to Dr. Sunil Aggarwal and Dr. Julie Holland who will speak to the science.
Dr. Aggarwal is a graduate of the University of Washington’s NIH sponsored medical scientist training program. He’s involved in physical medicine and rehabilitation. He has published studies of medical cannabis under some of the first ever granted certificates of confidentiality. He has authored some really amazing papers that we can give you access to that look at the science of cannabinoid use.
SUNIL AGGARWAL: I agree that compassion is certainly our guiding principle in medicine and we’re doing this for the sake of patients and their well-being but it is equally important to us that we are coming from a place that is informed by evidence and science.
I just want to share with folks here that the science behind the medical use of cannabis is very compelling, very strong. It’s really not a question any more in the debate of whether this substance has any medicinal utility. I think that is a settled issue with overwhelming medical consensus including organized medical groups like the American Medical Association, the American College of Physicians, Institute of Medicine. The question is what are we going to do now given that we have this information.
Just to highlight some of the major research accomplishments in this field…Marijuana is also called cannabis. It is an herbal cannabinoid drug. People have done studies with both the herbal material either in inhaled form or in oral form. People have done with the actual chemical constituents pulled out in pills and different topical preparations.
In 2007 there was a study that we had invested in 110 controlled clinical trials of cannabis and cannabinoids over 30 years. That involved over 6,100 patients. That is the amount of published human clinical data on this class of drug.
Turning to actual research which has been done in the United States with the federal cannabis supply which is a very restricted limited supply but is available from the University of Mississippi there’s been approximately 3 dozen clinical trials of inhaled cannabis. Nearly all of them have shown benefits for the drug in certain patient populations compared to placebo or to standard treatments.
About one-third of those studies are what are called ‘gold standards’. Those are double-blind, randomized, placebo controlled trials. Those were reviewed by the American Medical Association in its 1999 report and very unambiguously stated that these trials have shown patients who have no pain, patients who have pain due to nerve injury, patients who wasting syndrome, appetite loss and patients who have spasticity especially due to Multiple Sclerosis – all of those trials have been conducted and those patient populations in randomized fashion and have shown benefits for herbal cannabis.
These have been published in prestigious medical journals and conducted major American academic medical centers.
HOWARD GROSSMAN: Dr. Aggarwal, I’m going to ask you to sum up.
SUNIL AGGARWAL: The last thing to know is that even in New York oral forms of cannabis have been used in clinical studies and, in some cases, hundreds of patients in randomized controlled trials and those have shown benefits for patients with cancer-related pain and patients who have had Multiple Sclerosis-related pain as well. We’re talking about hundreds and hundreds of subjects.
The science is a settled issue as far as randomized trials showing benefits of cannabis in patient population. Now we have to act in a compassionate fashion with that information.
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DEAN BECKER: This is Dean Becker, your host, interrupting to say you are listening to Century of Lies on the Drug Truth Network. That was Dr. Sunil Aggarwal speaking at last week’s New York Physician for Compassionate Care conference regarding the medical use of cannabis.
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HOWARD GROSSMAN: Thank you very much. That was great. I want to turn it over to Dr. Julie Holland. Dr. Holland is a fellow at the New York Academy of Medicine. She was an assistant clinical professor of psychiatry at NYU from 1995 to 2012. She has done extensive research on the medical use of marijuana as well as the use of other controlled substances for relieving a number of different patient conditions.
Dr. Holland is going to speak to the safety issues around the medical use of marijuana. I want to mention to everybody that as physicians it is important to remember that we are constantly asked to prescribe medication that has significant safety issues. In pain management and in other things (and some of our other speakers will speak to this) we use opiods every day that have the potential for huge side effects including death which is something we don’t do with marijuana.
JULIE HOLLAND: Thanks, very much. I just want to say that I spent years and years editing a book called, “The Pot Book” which is a complete guide to cannabis. I’m the medical monitor for a clinical research study using cannabis to treat Post-Traumatic Stress Disorder.
I’m a psychiatrist in New York City. I’ve spent 9 years running the psychiatric emergency room at Bellevue Hospital and there I really saw the ravages primarily of alcohol and cocaine - never really so much with cannabis.
The thing that Howard said which is very important for us to remember about this ancient medicinal plant is that it is far less toxic than most of the medicine that we all prescribe and far less addictive than most of the medicine we prescribe and certainly in terms of the opiate pain medicine but also the stimulants and the benzodiapene. It has very low toxicity and a lower rate of addiction than many, many other drugs that I have used.
The other thing to keep in mind there is no lethal dose of cannabis. You can’t take so much that you stop breathing and that’s obviously not the case with the opiates.
Cannabis was a medicine way before it became an illegal drug. This an ancient medicinal plant that is one of the oldest cultivated plants that we know about and its use goes back at least 5,000 years.
We co-evolved on the planet with this plant and we have receptors in our brain for the plant. We have a whole system in our body called the endocannabinoid system so even if you’ve never smoked a joint you still have your own internal cannabis that helps to keep you healthy. It helps to balance out your metabolism, your immune system.
If you don’t quite understand why is it that pot does so many things it’s because you’ve got receptors all over your body for this medicine.
It diminishes nausea. It increases appetite. It is a pain medicine. It is an anti-inflammatory. It is a muscle relaxer. It is a free-radical scavenger the way vitamin E is. It modulates your immune system. It modulates your metabolism.
One interesting thing about pot smokers is they actually have better cholesterol waist circumference than non-pot smokers. I know that’s sort of counter-intuitive. You think that pot gives you the munchies but it turns out that when you’re looking at influence resistance and obesity the cannabinoid system is very much involved.
Even the United States which says that this is an illegal drug with no medicinal use holds a use patent on the neuro-protective properties of cannabis meaning that it can help protect against strokes and possibly neuro-degenerative diseases like Multiple Sclerosis, like Alzheimer’s Disease. There is recent amazing evidence that cannabis can kill cancer cells while leaving healthy cells intact.
So you’re not just talking about using cannabis for chemotherapy to combat the nausea and lack of appetite but you can actually start talking about using cannabis to treat cancer.
There was a very recent (I think it just came out yesterday) New England Journal of Medicine survey of thousands of doctors from around the world and all 50 states and I don’t know if you could get this many doctors to agree on anything but amazingly 76% of these doctors agreed that there should be medical marijuana and that cannabis has medicinal benefits and that we need to be able to prescribe it for people.
When I see a patient who I think could benefit from medicinal cannabis and I practice in New York and they say that’s great and where can I get it? I have to say to them, “Do you know any kids?” because kids can get pot. It’s very easy for any kid to get pot because dealers don’t card. It’s easier for them to get pot than it is to get alcohol.
It gets kind of crazy when my patients have to break the law to take a medicine that is less toxic than what’s available for them. I’d like to see that change.
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DEAN BECKER: I interrupt to remind you this was recorded last week at the New York Physicians for Compassionate Care press conference.
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HOWARD GROSSMAN: Our next speaker is Dr. Mark Pettus. Dr. Pettus is the Chief of Medicine at St. Peter’s Hospital in Albany and Clinical Associate of Medicine at the University of Massachusetts Medical School. He did much of his training at Harvard Medical School and a fellowship at Massachusetts General Hospital in Boston. He’s a fierce patient advocate and has written a lot about patient advocacy and holistic medicine.
MARK PETTUS: My clinical background is in internal medicine and neurology. I have long followed the science around cannabinoid use and have had many, many patients particularly with advanced renal disease and many of the complex, chronic diseases that all of the physicians on this call recognize are emerging in epidemic proportions who have confronted significant issues around pain, significant issues around neuropathy, significant issues around protracted nausea, vomiting for which all of the standard, FDA-approved medications have either been met with significant limitation or intolerable side effects.
I have long advocated for not only the efficacy of medical marijuana but as Dr. Holland just alluded to the enormous safety profile of this botanical. Certainly in inhaled form the bioavailability is immediate, it’s predictable and most of the people who are struggling with nausea, vomiting, absorption issues simply cannot tolerate oral forms of many of the medications that are approved for those problems.
I’ve also been very active in the development and implementation of integrated and holistic approaches to various chronic, complex diseases. Again, as Dr. Holland alluded to, there are just a diverse array of metabolic effects that cannabinoids are known to have that study after study demonstrate significant potential to modulate what are often dysfunctional metabolic underpinnings of many of the quality of life and day-to-day issues that many of our patients struggle with.
I just could not feel more strongly about moving forward with this and I do think compassionate is the key word here. We are healers and we are looking to do all we can to minimize and alleviate the suffering of those that we serve.
There’s a quote from Mark Twain who I think once said, “It’s not what we don’t know that gets us into trouble it’s what we know that ain’t so.” There’s a lot about medical marijuana that has been put out there that simply is not so. I think we’re at that crossroads now where it is time to step up and to do the right thing.
I have a lot of colleagues in Massachusetts who just greatly appreciated it finally getting passed for medical use there and I know that it is something that is going to be well-received both by the physicians there as well as those they serve.
I just feel very passionate about this. I’m glad to be a part of this call. I applaud the work of my colleagues who were presenting here this morning.
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DEAN BECKER: This was recorded last week at the New York Physicians for Compassionate Care press conference representing the opinion of more than 600 New York physicians.
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HOWARD GROSSMAN: Our last speaker is Dr. Craig Blenderman who is probably the reason that we’re here since he was the one who generated the letter and received this overwhelming response which made this group possible.
Dr. Blenderman is Director of the Adult Palliative Care Services and co-director of the Center for Support and Care for Clinical Services in the department of medicine at Columbia University here in Manhattan. He was previously on staff at Mass General Hospital in palliative care services and director of the MGH cancer clinic.
He is an expert in medical ethics, existential distress in cancer patients and symptom assessment in quality of life in chronic lung and heart failure patients as well as other topics. I’m happy to turn this over to Dr. Blenderman.
CRAIG BLENDERMAN: Thanks so much. Thanks for having me on this call today as well. This is really important legislation.
I got involved with these efforts to pass this bill because I think it’s the right thing to do. First and foremost, as physicians, we should say that from an ethical standpoint. To not allow to have the options for patients that could benefit from something there is a real moral fallout from that.
I think we have to ask ourselves as clinicians how can we allow for the status quo to continue when there are patients that could benefit from something that we could otherwise be able to prescribe to them.
I just want to put that out there that from an ethical standpoint this is the right thing to do given that there is so much evidence for its benefits. It just doesn’t make sense to deny this.
I got involved with this legislation because I recognized the need for my patients to have access to marijuana for relief from symptoms for some time. I deal with patients with advanced illness – often times with patients with cancer, advanced neurological illnesses or patients who have had serious illness or the consequences of acute injuries and so forth.
They end up finding ways to obtain or their family members find ways to obtain marijuana and then tell me about it. So they go about doing this illicitly with no control over the quality, potency or safety from what they’ve found on the streets or whatever way they’ve obtained it.
There is really no way for me to talk about their use and provide adequate guidance and counciling to administer and titrate and so forth the way I would do with other medications or other products.
That’s, I think, the first issue that why it’s so important is for us to really be able to talk openly with patients about the risks and benefits of using marijuana and how to actually use it safely and so forth - to have some kind of quality and control over this rather than patients just using it on their own which many of them have admitted to me that they do with much success.
So there’s that piece and I think it’s really important to take away that barrier. As Dr. Holland mentioned also the New England Journal of Medicine report that just came out today – if you talk to my colleagues everyone is very much in favor of using medical marijuana for their patients as well as themselves if they were to have these kinds of severe symptoms from medical illnesses.
As she pointed out about 76% of the physicians that responded to this case-based question were in favor of the use of medical marijuana. In this case it was describing a 68-year-old woman who had breast cancer with difficult to manage symptoms. It was a very typical type of patient that I might see.
I think relative to the world of palliative care in which I’ve been involved in for a number of years treating these patients at the end of life…you know, we get into really sticky situations where we’re using medications like opioids and other strong psychiatric medications, anti-nausea medications which all have very serious side effects. It’s not something that can just be easily ameliorated in a lot of patients.
I think that having the option of using medical marijuana for patients that have pain, that have nausea, that have difficult with appetite, that have spasticity, that have other problems that marijuana has been shown to be helpful for – it may benefit these patients in ways where we can actually reduce the dosages of opioids that they’re taking, for example for pain, reduce the need for multiple amounts of pills so the sort of pill burden that occurs…all of these kinds of things need to be reevaluated and studied more and we should be allowed the opportunity to use something like marijuana for the care of these patients so that they can have an improved quality of life as in nearing the end of their life.
HOWARD GROSSMAN: Great, thank you very much. I think it is very important that we make it clear for our audience that the way that federal policy is right now we can’t even study those things that you just mentioned that are so important because of the restrictions on the way it is classified.
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DEAN BECKER: Again, that was from the press conference for the New York Physicians for Compassionate Care held just last week. At least 600 New York doctors calling for the compassionate use of cannabis.
Regular listeners know that I’m a big fan of the good, the bad and the ugly – Clint Eastwood. Today we have “the good” - very, very good I would say. Next – the ugly which, by the way, was recorded the day after the New York Physicians conference which will be followed by, I would say, the best editorial ever.
The following segment courtesy FOX5 in New York.
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JOEL WALDMAN: Back in 2001, however, when Mayor Bloomberg ran for office he admitted that he had smoked pot when he was younger even admitted that he had enjoyed it but now he says that about the legalization of marijuana – it’s not the way to go.
Up in smoke is where Mayor Michael Bloomberg says he like to see a state measure go that if law would make marijuana legal for medicinal use only.
MICHAEL BLOOMBERG: Medical marijuana…well, medical, exactly – this is one of the great hoaxes of all times.
JOEL WALDMAN: Others say – not exactly.
DICK GOTTFRIED: Mayor Bloomberg contributed an enormous amount of money to have his name on the John Hopkin’s Medical School but he didn’t actually attend.
JOEL WALDMAN: Democratic State Assemblyman Dick Gottfried is co-sponsoring the medical marijuana bill. He says the mayor is wrong about it all being a hoax citing the findings of an administrative law judge from a Federal Drug Enforcement study done 25 years ago.
DICK GOTTFRIED: He said that the evidence in this report clearly shows that marijuana has been accepted as capable of relieving the distress of a great number of ill people and doing so with safety under medical supervision. He recommended that it be declared that it have legitimate medical use.
JOEL WALDMAN: Gottfried says the measure unlike California’s more liberal law is only for patients with severe, debilitating or life-threatening illnesses.
DICK GOTTFRIED: There would be extremely tight regulation on the production and the dispensing and the patients would have to have a written certification from a doctor and it would all have to be filed with the state health department.
JOEL WALDMAN: But the mayor is not buying it hinting that the effort to legalize pot is just under the guise of medical use possibly even being pushed by recreational users.
MICHAEL BLOOMBERG: Drug dealers have families to feed. If they can’t sell marijuana they’ll sell something else and the something else is going to be worse. The push to legalize this is just wrong-headed.
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DEAN BECKER: The following segment features Bill Maher.
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BILL MAHER: …and, finally, new rule, pot is the new gay marriage. By that I mean it is the next civil rights issue that needs to fall.
If Republicans were smart they would steal marijuana from the Democrats as a freedom issue. Of course they’re not smart so they won’t because they are squares living in a reefer madness cartoon – a cartoon where millions of Americans are still trapped in a no-man’s land where a pot dispensary can sell you weed if you have a “card” from a “doctor” who certifies that you have a “disease” which is just “don’t ask, don’t tell” for pot smokers.
It’s about the 3/4 of a million people who are arrested for simple possession every year and the fact that blacks are arrested at 7 times the rate of whites which is a subtle way to suppress the vote because 48 states limit voting rights for convicted felons – only 2 states do not – Maine and Vermont and Maine’s black population consists of a bear.
Look, we all put something in our mouth that we’re not always proud of but that makes us happy.
Gay barriers fell when Americans realized gays are their neighbors, their friends, their family members, their co-workers - certainly that must also be true of pot heads.
We all know at least one. In fact, I bet that there’s one pot head who you all know. [picture of Barack Obama on screen] Oh, not anymore but here he is back in high school with his stoner posse, the chun gang, posing with a cake that I’m guessing didn’t’ last long.
It makes me curious why he evolved so much on gay marriage but has actually escalated the war on pot. At the Correspondence Dinner this year he joked that, “I remember when buzz feed was something I did in college around 2 a.m.” which killed in the room but perhaps not so funny to all the lives ruined for doing the exact same thing he did back in Honolulu.
A simple pot conviction can foreclose on opportunities to vote, get a job, go to college or qualify for housing. How can our first black president and our first pot head president be aware of that and just look the other way?
If anyone can say smoking pot won’t ruin your life it’s the guy who smoked bales of it and later became leader of the free world.
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DEAN BECKER: How do you think New York Mayor Bloomberg would do in a debate against Bill Maher? How about against 6 New York physicians?
The drug war is an abject failure. 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
Transcript
Century of Lies / June 2, 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: Hi, this is Dean Becker, your host on Century of Lies. Thank you for being with us. The first segment we have today was recorded last week in New York where the New Physicians for Compassionate Care (some 600) strong held a press conference. This is part of that conference.
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HOWARD GROSSMAN: My name is Howard Grossman. I am an internist in private practice in New York. My specialties are primary care, lesbian/gay/bisexual/transgender medicine and HIV medicine.
I am the chair of a group called New York Physicians for Compassionate Care that is supporting the passage of the Compassionate Care in Albany that would allow doctors to talk about and prescribe the medical use of marijuana and cannabinoids.
We have a very distinguished group on the call that I will introduce – all physicians: Dr. Sunil Aggarwal, Dr. Julie Holland, Dr. Matthew Jackson (who will be joining us shortly), Dr. Mark Pettus, Dr. Craig Blenderman - all on the call who will speak to various issues regarding the medical use of marijuana.
We are going to follow that up with a question and answer session and we are going to try to give the most time to that so we’re going to keep our speakers to a very tight schedule and short statements.
All the doctors will be available for interviews following the conference. We want to use this call to announce the formation of New York Physicians for Compassionate Care.
Dr. Blenderman was the author of a letter that reached out to physicians asking them to support the Compassionate Care Act and to support the medical use of marijuana and there was a huge response – 730 responders from health care practitioners, 600 of them were from across the state of New York – up state, down state, mid-state you name it we have physicians who came out in support of this bill and of the use of medical marijuana.
We are also glad that there is support from the New York State Nurse Association, the Pharmacist Society in the State of New York. We’re here to speak on behalf of physicians because physicians voices have not really been heard that much in this debate.
Our biggest issue here is one of compassion. We are calling for compassion for our patients and compassion for doctors who wish to talk about a useful and safe medication for use in people with serious illness.
The New York State proposal is one of the most tightly regulated proposal in the country. There are, at this time, 18 states and the District of Columbia that allow the medical use of marijuana. The New York statute is designed to work off the strengths of those other states’ experiences as well as to deal with some of the weaknesses that have been shown in some of those other states in the way that they’ve rolled things out.
This is really an amazing accomplishment. This bill strikes a balance between ensuring patient access , preventing diversion and giving the doctor the opportunity to talk to patients, recommend medical marijuana for those patients with serious or debilitating conditions that might benefit from it.
As physicians we always start from the science and that is a very important component for us. I’m going to turn this over now to Dr. Sunil Aggarwal and Dr. Julie Holland who will speak to the science.
Dr. Aggarwal is a graduate of the University of Washington’s NIH sponsored medical scientist training program. He’s involved in physical medicine and rehabilitation. He has published studies of medical cannabis under some of the first ever granted certificates of confidentiality. He has authored some really amazing papers that we can give you access to that look at the science of cannabinoid use.
SUNIL AGGARWAL: I agree that compassion is certainly our guiding principle in medicine and we’re doing this for the sake of patients and their well-being but it is equally important to us that we are coming from a place that is informed by evidence and science.
I just want to share with folks here that the science behind the medical use of cannabis is very compelling, very strong. It’s really not a question any more in the debate of whether this substance has any medicinal utility. I think that is a settled issue with overwhelming medical consensus including organized medical groups like the American Medical Association, the American College of Physicians, Institute of Medicine. The question is what are we going to do now given that we have this information.
Just to highlight some of the major research accomplishments in this field…Marijuana is also called cannabis. It is an herbal cannabinoid drug. People have done studies with both the herbal material either in inhaled form or in oral form. People have done with the actual chemical constituents pulled out in pills and different topical preparations.
In 2007 there was a study that we had invested in 110 controlled clinical trials of cannabis and cannabinoids over 30 years. That involved over 6,100 patients. That is the amount of published human clinical data on this class of drug.
Turning to actual research which has been done in the United States with the federal cannabis supply which is a very restricted limited supply but is available from the University of Mississippi there’s been approximately 3 dozen clinical trials of inhaled cannabis. Nearly all of them have shown benefits for the drug in certain patient populations compared to placebo or to standard treatments.
About one-third of those studies are what are called ‘gold standards’. Those are double-blind, randomized, placebo controlled trials. Those were reviewed by the American Medical Association in its 1999 report and very unambiguously stated that these trials have shown patients who have no pain, patients who have pain due to nerve injury, patients who wasting syndrome, appetite loss and patients who have spasticity especially due to Multiple Sclerosis – all of those trials have been conducted and those patient populations in randomized fashion and have shown benefits for herbal cannabis.
These have been published in prestigious medical journals and conducted major American academic medical centers.
HOWARD GROSSMAN: Dr. Aggarwal, I’m going to ask you to sum up.
SUNIL AGGARWAL: The last thing to know is that even in New York oral forms of cannabis have been used in clinical studies and, in some cases, hundreds of patients in randomized controlled trials and those have shown benefits for patients with cancer-related pain and patients who have had Multiple Sclerosis-related pain as well. We’re talking about hundreds and hundreds of subjects.
The science is a settled issue as far as randomized trials showing benefits of cannabis in patient population. Now we have to act in a compassionate fashion with that information.
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DEAN BECKER: This is Dean Becker, your host, interrupting to say you are listening to Century of Lies on the Drug Truth Network. That was Dr. Sunil Aggarwal speaking at last week’s New York Physician for Compassionate Care conference regarding the medical use of cannabis.
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HOWARD GROSSMAN: Thank you very much. That was great. I want to turn it over to Dr. Julie Holland. Dr. Holland is a fellow at the New York Academy of Medicine. She was an assistant clinical professor of psychiatry at NYU from 1995 to 2012. She has done extensive research on the medical use of marijuana as well as the use of other controlled substances for relieving a number of different patient conditions.
Dr. Holland is going to speak to the safety issues around the medical use of marijuana. I want to mention to everybody that as physicians it is important to remember that we are constantly asked to prescribe medication that has significant safety issues. In pain management and in other things (and some of our other speakers will speak to this) we use opiods every day that have the potential for huge side effects including death which is something we don’t do with marijuana.
JULIE HOLLAND: Thanks, very much. I just want to say that I spent years and years editing a book called, “The Pot Book” which is a complete guide to cannabis. I’m the medical monitor for a clinical research study using cannabis to treat Post-Traumatic Stress Disorder.
I’m a psychiatrist in New York City. I’ve spent 9 years running the psychiatric emergency room at Bellevue Hospital and there I really saw the ravages primarily of alcohol and cocaine - never really so much with cannabis.
The thing that Howard said which is very important for us to remember about this ancient medicinal plant is that it is far less toxic than most of the medicine that we all prescribe and far less addictive than most of the medicine we prescribe and certainly in terms of the opiate pain medicine but also the stimulants and the benzodiapene. It has very low toxicity and a lower rate of addiction than many, many other drugs that I have used.
The other thing to keep in mind there is no lethal dose of cannabis. You can’t take so much that you stop breathing and that’s obviously not the case with the opiates.
Cannabis was a medicine way before it became an illegal drug. This an ancient medicinal plant that is one of the oldest cultivated plants that we know about and its use goes back at least 5,000 years.
We co-evolved on the planet with this plant and we have receptors in our brain for the plant. We have a whole system in our body called the endocannabinoid system so even if you’ve never smoked a joint you still have your own internal cannabis that helps to keep you healthy. It helps to balance out your metabolism, your immune system.
If you don’t quite understand why is it that pot does so many things it’s because you’ve got receptors all over your body for this medicine.
It diminishes nausea. It increases appetite. It is a pain medicine. It is an anti-inflammatory. It is a muscle relaxer. It is a free-radical scavenger the way vitamin E is. It modulates your immune system. It modulates your metabolism.
One interesting thing about pot smokers is they actually have better cholesterol waist circumference than non-pot smokers. I know that’s sort of counter-intuitive. You think that pot gives you the munchies but it turns out that when you’re looking at influence resistance and obesity the cannabinoid system is very much involved.
Even the United States which says that this is an illegal drug with no medicinal use holds a use patent on the neuro-protective properties of cannabis meaning that it can help protect against strokes and possibly neuro-degenerative diseases like Multiple Sclerosis, like Alzheimer’s Disease. There is recent amazing evidence that cannabis can kill cancer cells while leaving healthy cells intact.
So you’re not just talking about using cannabis for chemotherapy to combat the nausea and lack of appetite but you can actually start talking about using cannabis to treat cancer.
There was a very recent (I think it just came out yesterday) New England Journal of Medicine survey of thousands of doctors from around the world and all 50 states and I don’t know if you could get this many doctors to agree on anything but amazingly 76% of these doctors agreed that there should be medical marijuana and that cannabis has medicinal benefits and that we need to be able to prescribe it for people.
When I see a patient who I think could benefit from medicinal cannabis and I practice in New York and they say that’s great and where can I get it? I have to say to them, “Do you know any kids?” because kids can get pot. It’s very easy for any kid to get pot because dealers don’t card. It’s easier for them to get pot than it is to get alcohol.
It gets kind of crazy when my patients have to break the law to take a medicine that is less toxic than what’s available for them. I’d like to see that change.
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DEAN BECKER: I interrupt to remind you this was recorded last week at the New York Physicians for Compassionate Care press conference.
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HOWARD GROSSMAN: Our next speaker is Dr. Mark Pettus. Dr. Pettus is the Chief of Medicine at St. Peter’s Hospital in Albany and Clinical Associate of Medicine at the University of Massachusetts Medical School. He did much of his training at Harvard Medical School and a fellowship at Massachusetts General Hospital in Boston. He’s a fierce patient advocate and has written a lot about patient advocacy and holistic medicine.
MARK PETTUS: My clinical background is in internal medicine and neurology. I have long followed the science around cannabinoid use and have had many, many patients particularly with advanced renal disease and many of the complex, chronic diseases that all of the physicians on this call recognize are emerging in epidemic proportions who have confronted significant issues around pain, significant issues around neuropathy, significant issues around protracted nausea, vomiting for which all of the standard, FDA-approved medications have either been met with significant limitation or intolerable side effects.
I have long advocated for not only the efficacy of medical marijuana but as Dr. Holland just alluded to the enormous safety profile of this botanical. Certainly in inhaled form the bioavailability is immediate, it’s predictable and most of the people who are struggling with nausea, vomiting, absorption issues simply cannot tolerate oral forms of many of the medications that are approved for those problems.
I’ve also been very active in the development and implementation of integrated and holistic approaches to various chronic, complex diseases. Again, as Dr. Holland alluded to, there are just a diverse array of metabolic effects that cannabinoids are known to have that study after study demonstrate significant potential to modulate what are often dysfunctional metabolic underpinnings of many of the quality of life and day-to-day issues that many of our patients struggle with.
I just could not feel more strongly about moving forward with this and I do think compassionate is the key word here. We are healers and we are looking to do all we can to minimize and alleviate the suffering of those that we serve.
There’s a quote from Mark Twain who I think once said, “It’s not what we don’t know that gets us into trouble it’s what we know that ain’t so.” There’s a lot about medical marijuana that has been put out there that simply is not so. I think we’re at that crossroads now where it is time to step up and to do the right thing.
I have a lot of colleagues in Massachusetts who just greatly appreciated it finally getting passed for medical use there and I know that it is something that is going to be well-received both by the physicians there as well as those they serve.
I just feel very passionate about this. I’m glad to be a part of this call. I applaud the work of my colleagues who were presenting here this morning.
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DEAN BECKER: This was recorded last week at the New York Physicians for Compassionate Care press conference representing the opinion of more than 600 New York physicians.
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HOWARD GROSSMAN: Our last speaker is Dr. Craig Blenderman who is probably the reason that we’re here since he was the one who generated the letter and received this overwhelming response which made this group possible.
Dr. Blenderman is Director of the Adult Palliative Care Services and co-director of the Center for Support and Care for Clinical Services in the department of medicine at Columbia University here in Manhattan. He was previously on staff at Mass General Hospital in palliative care services and director of the MGH cancer clinic.
He is an expert in medical ethics, existential distress in cancer patients and symptom assessment in quality of life in chronic lung and heart failure patients as well as other topics. I’m happy to turn this over to Dr. Blenderman.
CRAIG BLENDERMAN: Thanks so much. Thanks for having me on this call today as well. This is really important legislation.
I got involved with these efforts to pass this bill because I think it’s the right thing to do. First and foremost, as physicians, we should say that from an ethical standpoint. To not allow to have the options for patients that could benefit from something there is a real moral fallout from that.
I think we have to ask ourselves as clinicians how can we allow for the status quo to continue when there are patients that could benefit from something that we could otherwise be able to prescribe to them.
I just want to put that out there that from an ethical standpoint this is the right thing to do given that there is so much evidence for its benefits. It just doesn’t make sense to deny this.
I got involved with this legislation because I recognized the need for my patients to have access to marijuana for relief from symptoms for some time. I deal with patients with advanced illness – often times with patients with cancer, advanced neurological illnesses or patients who have had serious illness or the consequences of acute injuries and so forth.
They end up finding ways to obtain or their family members find ways to obtain marijuana and then tell me about it. So they go about doing this illicitly with no control over the quality, potency or safety from what they’ve found on the streets or whatever way they’ve obtained it.
There is really no way for me to talk about their use and provide adequate guidance and counciling to administer and titrate and so forth the way I would do with other medications or other products.
That’s, I think, the first issue that why it’s so important is for us to really be able to talk openly with patients about the risks and benefits of using marijuana and how to actually use it safely and so forth - to have some kind of quality and control over this rather than patients just using it on their own which many of them have admitted to me that they do with much success.
So there’s that piece and I think it’s really important to take away that barrier. As Dr. Holland mentioned also the New England Journal of Medicine report that just came out today – if you talk to my colleagues everyone is very much in favor of using medical marijuana for their patients as well as themselves if they were to have these kinds of severe symptoms from medical illnesses.
As she pointed out about 76% of the physicians that responded to this case-based question were in favor of the use of medical marijuana. In this case it was describing a 68-year-old woman who had breast cancer with difficult to manage symptoms. It was a very typical type of patient that I might see.
I think relative to the world of palliative care in which I’ve been involved in for a number of years treating these patients at the end of life…you know, we get into really sticky situations where we’re using medications like opioids and other strong psychiatric medications, anti-nausea medications which all have very serious side effects. It’s not something that can just be easily ameliorated in a lot of patients.
I think that having the option of using medical marijuana for patients that have pain, that have nausea, that have difficult with appetite, that have spasticity, that have other problems that marijuana has been shown to be helpful for – it may benefit these patients in ways where we can actually reduce the dosages of opioids that they’re taking, for example for pain, reduce the need for multiple amounts of pills so the sort of pill burden that occurs…all of these kinds of things need to be reevaluated and studied more and we should be allowed the opportunity to use something like marijuana for the care of these patients so that they can have an improved quality of life as in nearing the end of their life.
HOWARD GROSSMAN: Great, thank you very much. I think it is very important that we make it clear for our audience that the way that federal policy is right now we can’t even study those things that you just mentioned that are so important because of the restrictions on the way it is classified.
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DEAN BECKER: Again, that was from the press conference for the New York Physicians for Compassionate Care held just last week. At least 600 New York doctors calling for the compassionate use of cannabis.
Regular listeners know that I’m a big fan of the good, the bad and the ugly – Clint Eastwood. Today we have “the good” - very, very good I would say. Next – the ugly which, by the way, was recorded the day after the New York Physicians conference which will be followed by, I would say, the best editorial ever.
The following segment courtesy FOX5 in New York.
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JOEL WALDMAN: Back in 2001, however, when Mayor Bloomberg ran for office he admitted that he had smoked pot when he was younger even admitted that he had enjoyed it but now he says that about the legalization of marijuana – it’s not the way to go.
Up in smoke is where Mayor Michael Bloomberg says he like to see a state measure go that if law would make marijuana legal for medicinal use only.
MICHAEL BLOOMBERG: Medical marijuana…well, medical, exactly – this is one of the great hoaxes of all times.
JOEL WALDMAN: Others say – not exactly.
DICK GOTTFRIED: Mayor Bloomberg contributed an enormous amount of money to have his name on the John Hopkin’s Medical School but he didn’t actually attend.
JOEL WALDMAN: Democratic State Assemblyman Dick Gottfried is co-sponsoring the medical marijuana bill. He says the mayor is wrong about it all being a hoax citing the findings of an administrative law judge from a Federal Drug Enforcement study done 25 years ago.
DICK GOTTFRIED: He said that the evidence in this report clearly shows that marijuana has been accepted as capable of relieving the distress of a great number of ill people and doing so with safety under medical supervision. He recommended that it be declared that it have legitimate medical use.
JOEL WALDMAN: Gottfried says the measure unlike California’s more liberal law is only for patients with severe, debilitating or life-threatening illnesses.
DICK GOTTFRIED: There would be extremely tight regulation on the production and the dispensing and the patients would have to have a written certification from a doctor and it would all have to be filed with the state health department.
JOEL WALDMAN: But the mayor is not buying it hinting that the effort to legalize pot is just under the guise of medical use possibly even being pushed by recreational users.
MICHAEL BLOOMBERG: Drug dealers have families to feed. If they can’t sell marijuana they’ll sell something else and the something else is going to be worse. The push to legalize this is just wrong-headed.
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DEAN BECKER: The following segment features Bill Maher.
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BILL MAHER: …and, finally, new rule, pot is the new gay marriage. By that I mean it is the next civil rights issue that needs to fall.
If Republicans were smart they would steal marijuana from the Democrats as a freedom issue. Of course they’re not smart so they won’t because they are squares living in a reefer madness cartoon – a cartoon where millions of Americans are still trapped in a no-man’s land where a pot dispensary can sell you weed if you have a “card” from a “doctor” who certifies that you have a “disease” which is just “don’t ask, don’t tell” for pot smokers.
It’s about the 3/4 of a million people who are arrested for simple possession every year and the fact that blacks are arrested at 7 times the rate of whites which is a subtle way to suppress the vote because 48 states limit voting rights for convicted felons – only 2 states do not – Maine and Vermont and Maine’s black population consists of a bear.
Look, we all put something in our mouth that we’re not always proud of but that makes us happy.
Gay barriers fell when Americans realized gays are their neighbors, their friends, their family members, their co-workers - certainly that must also be true of pot heads.
We all know at least one. In fact, I bet that there’s one pot head who you all know. [picture of Barack Obama on screen] Oh, not anymore but here he is back in high school with his stoner posse, the chun gang, posing with a cake that I’m guessing didn’t’ last long.
It makes me curious why he evolved so much on gay marriage but has actually escalated the war on pot. At the Correspondence Dinner this year he joked that, “I remember when buzz feed was something I did in college around 2 a.m.” which killed in the room but perhaps not so funny to all the lives ruined for doing the exact same thing he did back in Honolulu.
A simple pot conviction can foreclose on opportunities to vote, get a job, go to college or qualify for housing. How can our first black president and our first pot head president be aware of that and just look the other way?
If anyone can say smoking pot won’t ruin your life it’s the guy who smoked bales of it and later became leader of the free world.
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DEAN BECKER: How do you think New York Mayor Bloomberg would do in a debate against Bill Maher? How about against 6 New York physicians?
The drug war is an abject failure. 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