05/15/11 Marsha Rosenbaum

Cannabis Safety: Marsha Rosenbaum, Amanda Reiman, Dale Geringer & Steve Dillon + Al Coles of CBD Science

Century of Lies
Sunday, May 15, 2011
Marsha Rosenbaum
Drug Policy Alliance
Download: Audio icon COL_051511.mp3


Century of Lies Transcript
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.
DEAN BECKER: Hello, my friends. This is Dean Becker; I wanna welcome you to this edition of Century of Lies. Today, we're going to reach back about a month ago to a panel on safety at the National Organization for the Reform of Marijuana Laws Conference in Denver, Colorado. To introduce this panel, we have Mr. Steve Dillon, the Chairman of the Board of the National Organization for the Reform of Marijuana Laws.
STEPHEN DILLON: Marijuana and Safety: Real Myths. Real Concerns. You know, the government’s been lying to our children for decades. It's time that we told the truth to our children. We owe them that; we gotta think about the kids. It's time that we did exactly that and focus on the future. We've got to tell the truth to our children about marijuana. If we tell them that marijuana's like crack cocaine, they may try crack cocaine. So, let's not lie to the kids.

Today, we have an extraordinary panel to talk about the truth about marijuana and safety. Our moderator of the panel is Dr. Marsha Rosenbaum; she's the Director Emerita of the San Francisco office of the Drug Policy Alliance. She created Safety First, which is a wonderful pamphlet if you haven't read it; and it talks about drugs and children, that’s her focus. It's a booklet that she produced. She got her PhD in—let’s see—Medical Sociology from the University of San Francisco in 1979.

She was a principal investigator in a National Institute of Drug Abuse study on heroin addiction, methadone maintenance, MDMA and cocaine use during pregnancy. She's written several books including Women on Heroin, Pursuit of Ecstasy, Pregnant Women on Drugs. She's written numerous articles. She's a regular speaker, an excellent speaker, and she tells the truth. She’s the one you want to talk to your school board about drugs. Dr. Marsha Rosenbaum.
MARSHA ROSENBAUM: Good. So we have a panel of—I have to say—incredible panel of experts to talk about what’s real what’s not real; what are the myths, what are the facts; what is safe, what is not safe; about a range of activities around marijuana, medical marijuana. Our first speaker is Amanda Reiman, who is Director of Research at the Berkeley Patients Group and a social scientist studying marijuana use. And she is gonna talk to us about naive medical cannabis patients. And I'll introduce the next speakers as we go. So, Amanda.

AMANDA REIMAN: So, today I'm gonna be talking about educating the naive patient; from harm reduction to benefit maximization. And this is really built off a demographic trend that we're starting to see with medical cannabis patients involving the age of medical cannabis patients and the experience that people have with cannabis before they become patients.

And I wanna talk a little bit about maybe how we who work in this field and with this movement can help meet the needs of this patient group; because as people that really are promoting the therapeutic use of cannabis, we want individuals who come to us looking for relief and a safe effective medicine to have a good experience. Because if they come and have a horrific experience, guess what? They're gonna go back and they're gonna tell all their friends, who are gonna say, "I told you you shouldn't have gotten involved with that anyway." And they're gonna say, "Yeah, you’re right. I really had a bad experience.” And compare this to somebody who comes in and tells their friends and family, "No, you've got it all wrong. You've got this idea about marijuana wrong. Because now I know that it's working for me, and I've had a great experience.” And this can really be a turning point in bringing people into this movement.

So I’m gonna talk about meeting these needs in the context of both harm reduction and benefit maximization through the mechanisms of education, implementation and evaluation, and that what some of the next steps are to working with this population.

So how do we know this is happening? Well, I collected three hundred and four anonymous surveys at Berkeley Patients Group at intake; so individuals that were coming to become new members of our collective. Just some background demographics on this sample: they were 74% male, 57% white. The mean age was 32. 75% of the sample used cannabis for a pain-related condition, and 86 of the 304 patients reported having more than one condition.

And this does feed into why some people are coming into cannabis, because they’re on three, four, five medications and are trying to reduce that poly-substance use. Something that was really interesting was that almost 20% of that sample report using cannabis for the very first time in the last six months. And these individuals were significantly more likely to be Latino or African American.

So how does this differ from previous data that we've collected on patients? Why did this kind of put an alarm in my head? Well, it's the 20% of new patients that have used cannabis for the very first time in the past six months; and it was the fact that their mean age was 32. Because in 2008, I collected data from 350 patients of Berkeley Patients Group, and then the mean age was 39.

So why is this happening? Well, this is my own personal hypothesis: in California, we’ve had medical marijuana since 1996. It's not that difficult to obtain a medical marijuana recommendation in California, and you can get one for any condition for which marijuana provides relief. So what that meant is that in the first few years of the program, we were seeing individuals who were regular cannabis users who were now going to get medical cannabis cards so they can come and use their medicine legally in a controlled environment. But that's past now.

Pretty much everyone in California who’s a regular cannabis user who wants to have a medical cannabis card, has one in the year 2011; but yet we're seeing new patients every day. So who are these individuals? Well, these individuals are people that just turned eighteen and now can go and get a medical cannabis card, or they're individuals who are new to cannabis use in general.

So today I wanna focus a little bit on meeting the needs of this individual who's brand new to cannabis use. Now they have their medical cannabis card, and they're coming to a dispensary to get their medicine. So what do we know about these individuals? Well, we know that they come to cannabis for a wide variety of reasons. Some have had a lack of success with traditional treatment; some suffer a catastrophic illness that puts things in a different perspective for them in terms of their medical treatment. And we have a growing number of people, especially young people who have beliefs about pharmaceuticals and are finally realizing the dangers associated with some of the medications they're being asked to take to treat certain conditions and they would rather use cannabis instead.

Which is really fascinating to me because it—when we first started having this conversation medical cannabis was looked at as kind of like a last line of defense. You tried everything else, so now we'll give you cannabis. But what I hear from young patients coming in today is, "Well I'm gonna try this first, and if this doesn't work, maybe I'll try Vicodin. If this doesn't work, maybe I'll try Xanax. But if cannabis works, I'd much rather use that."

Naive patients do not possess the language to express their needs. They don't know what full melt hash is; they don’t understand why certain strains are better when they're grown outdoors; they don’t understand what a three-dose cookie means in terms of getting relief. So we have to educate these individuals and give them the words they need in order to have their needs met. We also know that naive patients may not have a guide to lead them through the process of selection and ingestion; and this is very important in learning to reduce harm and maximize benefits, and I’ll talk a bit more about this.

And they also might be intimidated and have preconceived propaganda-based notions of cannabis. So these individuals may be coming into medical cannabis despite all the words in their heads and from friends and family that are saying, “you shouldn’t do this this is a drug. This is dangerous.” But yet they're coming to you anyway.

So harm reduction and benefit maximization are actually two sides of the same coin. And in the CBD talk yesterday, Steve Deangelo mentioned the idea of making sure cannabis didn’t harm anyone, but also making sure that people got the right dose so the medicine CNA be effective. So that’s what we’re talking about here: reducing the chance of a negative experience from using cannabis and increasing the chance of having a positive experience from using cannabis.

So how do we reduce the harm that might occur when somebody is new to cannabis? Well, first we have to be honest. Negative experiences from cannabis can occur. They can include anxiety, upset stomach, rapid heart rate. And that these negative effects are more common in naive users because for individuals who have these effects persist, a lot of them just stop using cannabis.
DEAN BECKER: You are listening to Century of Lies on the Drug Truth Network and Pacifica Radio. We're tuning in to a conference last month in Denver, sponsored by the National Organization for the Reform of Marijuana Laws. The title of this panel was Cannabis Safety; the speaker you're listening to is Amanda Reiman.
AMANDA REIMAN: Oh, and legal sanctions of course are another negative experience that one can have from using medical cannabis. So people also need to be educated on what risks they're taking with their own cannabis use.

Another way to reduce harm is to stress the importance of set and setting—and this is language that you hear a lot in substance abuse treatment. The idea is that we all have a biological set that determines how we react to a certain drug, but just as important is the setting in which that drug is ingested. So the environment in which a naive user is utilizing their medicine becomes of the utmost importance, and here’s where dispensaries can play an important role.

Harm reduction also involves information about dependence and withdrawal that should be presented honestly. So many times in a dispensary, I hear a new patient ask someone that’s working there, you know, “Is cannabis addictive? Are there any withdrawal symptoms?” And before they can even stop the sentence, the person's like "no, no no, no no, cannabis is non-addictive. There's no withdrawal symptoms whatsoever,"

And while it's true that compared to other substances, the risk of withdrawal dependence is way, way lower; and it's true that the withdrawal symptoms that may be associated with cannabis use are not disruptive in the same physical and psychological way, they do exist. And patients need to know this so that they can use the medicine safely and effectively.

And finally harm reduction involves navigating patient’s status among friends families and employers. This is especially important for younger patients. Coming out as a medical cannabis patient has a lot of risks associated with it; and for a new cannabis user, they may need some help in how to have that conversation with their parent, with their teacher with their employer, with their child about their decision to use cannabis.

Benefit maximization's a lot simpler. Cost effectiveness—make each dollar count. Patients really have to have information about what they're using so that they can make that dollar stretch, because medical cannabis is not cheap. Symptom-specific medicine, efficacy and efficiency; making sure that the medicine people choose not only works for them, but that its efficient and works for them.

So this might be method of ingestion. This might be choosing very specific strains and finally maximizing the benefits by exploring all the different methods of ingestion. So I have on here salves, who knew? Because when I give talks about medical cannabis to individuals and I tell them that there is a topical ointment—I call it organic Ben Gay—that you can put on your aching joints, that you can put on your aching muscles, that it will not get you high that it is all natural, they think that I’ve shown them the holy grail. And we need to really promote these other ways to ingest cannabis.

So what are the next steps for this? Well, cannabis 101: we need to start with education. New patients need to develop a language. We need to demystify it; we need to allow them to get the cannabis out of the jar, play around with it, smell it, feel it, see how it feels on their fingers. We need to review the legal status so that they can protect themselves.

We need to teach patients how to handle those negative experiences. We need to tell them how to talk themselves down from being over-medicated from an edible. We need to talk to them about taking precautions and what to do if they become over medicated—but not to panic. Because as was mentioned in the previous panel, that’s what a lot of the emergency room visits are. They're people panicking over being over medicated.

We also need to teach them about dependence and withdrawal. Industry professionals also need to receive basic education on answering these questions. Every single person working in this industry should know about what the withdrawal and dependency risks are for cannabis. Every single person working in this industry should know what the legal situation is in your jurisdiction, so that you can answer these questions for your patients. And we need guide to medicate with the patients for the first time as part of implementation.
Doctor Grinspoon mentioned yesterday about suggesting that elderly patients talk to their grandchildren about helping them when they first start to use medical cannabis. But I think that dispensaries need to have a Patient Liaison on site to help new patients experience medication for the first time.

And finally workshops on assessing the effects of cannabis, so that we can really evaluate what works best for the patient. This includes classes on bioassay methods and other ways that patients can maximize that experience, so that they have a positive experience.

So just on a personal note, I'm a Lecturer at UC Berkeley. One of my colleagues—who's an elderly woman—that suffers from such severe pain due to neuropathy that she had to stop teaching. She had never used cannabis before; she was a little bit nervous about it. She came to talk to me about it. I gave her some suggestions, and I told her what dispensary I recommended.

She had tears in her eyes when she came back to me because she said, "They cared for me in a way that nobody else in the entire medical community that I've gone to so far has shown me care," and she was so happy about it she said, "I'm gonna tell all my friends. They need to try this; this is a really good option." And so there's a whole new group of supporters. There’s a whole new group of people that now understand how powerful this medicine is.

Again thank you to NORML for inviting me to speak.


MARSHA ROSENBAUM: Thank you, Amanda. Now our next speaker who really, really needs no introduction—but I wanna introduce you anyway. Dale Geringer has been in the marijuana movement for all of these forty years except one… No. See, I'm introducing you and you're conflicting.

DALE GERINGER: Since 1987.

MARSHA ROESENBAUM: Nineteen eighty--excuse me. He is—he is a political genius, I think. He is in my state of California; he is my go to person with all questions political about marijuana and some not about marijuana. So—and we're not gonna talk politics right now; but dale is gonna talk to you about the exaggerated hazards of driving under the influence of marijuana.


DALE GERINGER: Okay, okay, thank you very much. Now, marijuana and driving as we know is actually a very hot issue. It was one of the leading concerns that was expressed by our opposition in the Prop 19 campaign. Comes up all the time when you're discussing marijuana legalization.

Now, I'm gonna try to show you why concerns about an epidemic of casualties from marijuana—from stoned drivers are highly exaggerated. But I would remind you of what the very first federal Drug Czar Harry Anslinger said, that legalizing marijuana would mean slaughter on the highways. Most of what Mr. Anslinger ever said about marijuana was wrong. I'monna try to convince you of the same thing.

But first, I'm gonna have to come up with a disclaimer especially at this conference. Let me say at the outset marijuana does have proven adverse effects on driving skills. Studies—and there've been a lot of ‘em—show that marijuana can impair concentration, reaction time—especially complex reaction time where you have decisions to make, peripheral vision, steadiness of speed, distance, decision-making skills, other driving skills in general, and there's a lot of evidence that shows this.

Most of these studies were actually driver-simulated studies or laboratory studies, not so much on the road. Lots of lots of studies—761 studies. The analysis shows that over 50% of the six hundred and seven hundred and sixty one studies showed impairment from THC. Only three studies showed any improvement whatsoever. So those of you out there who insisted marijuana makes you drive more safely, there's not a lot of evidence out there to back you up.

There—seventy percent of the tests showed impairment at twenty to forty minutes. Then that percentage sort of declines, and then after two and a half hours—and this is not on the chart there—there are some minor measurable effects that are not of a whole lot of concern. After four hours nobody can really find anything.

But this first two and a half hours—especially this twenty to forty minutes—are a concern. So, with this concern in mind, how are we gonna you know measure this? How is law enforcement gonna detect it? Well, of course a lot of people talk about drug tests, so let us move on and look at the technology there.

I don’t have to tell this group this about urine tests, the most popular form of drug testing that we have. Have nothing to do with impairment, the reason being simply that marijuana tests—urine tests positive for days after use. And it’s very hard to relate that to any temporary degradation of driving skills. And htis shows—the results shows how users will test positive for marijuana at significant levels of urine, for up to 70 days in this particular survey.

So really, most safety experts realize this fact that urinalysis is no way to measure impairment, despite the fact that we have Department of Transportation rules that require mandatory drug testing of all our truckers and transportation workers. There's really no evidence to show that the urine tests have anything to do with their present impairment.

Less known, and this is something that I always find useful to throw at my enemies, is that urine tests don’t even show when you're very stoned. Because your urine doesn't turn positive until a few hours after you actually smoke. So if you're clean and then get plastered, it can still be two, four, or six hours before any of the metabolite actually gets into your urine. Well as we said before, the most dangerous time is the first two hours. You're not even positive then.

I think this highlights what a wrongheaded technology urine testing is when it comes to detecting impairment. So what do people turn to? What kind of tests do we have? Well, the standard that everyone looks at now is blood tests because blood tests actually detect the presence of active THC in your bloodstream, and it—this tends to be highly responsive to recent use.
DEAN BECKER: Ah yes, you're listening to Century of Lies on the Drug Truth Network and Pacifica Radio we're tuning into the recent NORML conference up in Denver, Colorado. The panel we're listening to: Marijuana and Safety. The speaker, Dale Geringer of California NORML.
DALE GERINGER: After smoking marijuana, the time scale where I guess the whole thing goes out for about—for a few hours here, but that peak is very, very brief. It’s a few minutes really; very sharp peak that declines. And after an hour or two, it goes down to much lower levels.

The peak is ov—in this case, in these average—this is an average of many subjects was over a hundred nanograms per milliliter. That's high. If you see a hundred nanograms per milliiliter, chances are the person smoked really recently. But it tails off and then after a few hours, it goes down to these minimal levels of between one and three nanograms per milliliter. And that can persist for many hours. And in fact, in the latest studies, up to six days in chronic users you can see levels from one to three nanograms residual THC in the blood.

Now some states have zero THC-in-blood standard. But as you can see, that would—again—be detecting usage, you know, possibly days after it's actually happened. However, if it's above three nanograms, there's probably been recent use.

Now there's another hooker in this, makes it more complicated: the red line down there shows what happens if you take an oral dose of marijuana, and that's much different. you do not get a peak at all. You get this low broad plateau of somewhere from five to ten nanograms. Now that's again above that two to three that I said is common residually, but it's not that high compared to the peak that you see.

So that's--and you can be much more stoned with, you know, showing five or six nanograms in your blood because you ate a brownie, than you might be for having taken a few puffs of a joint and registering at a hundred nanograms; which illustrates my point that blood THC does not track the actual subjective effects of marijuana.
DEAN BECKER: All right, once again that was Dale Geringer speaking on the cannabis safety panel at the NORML Conference held in Denver last month. You can check out many of those panels online by visiting their website, NORML.org. Here's a more recent interview I conducted with Mr. Al Coles.
AL COLES: I'm the founder of CBD Science, and we're the producers and developers of a cannabis-based medicinal extract called "Alta California." And it’s the first CBME, for short, that is safe certified and potency verified.
And we do three different types of tinctures. The first is a typical one that's available through which is a high THC, low CBD, and it's called "Euphoria." The other is a high CBD, low THC that is called "Healing." And the last one that is the most exciting to me is called "Tranquility," and that is 50% THC and 50% CBD.

And these are potency verified; every bottle, every dropper is the same precise amount. So we can know exactly what we need for our—for our--you know, for healing.

DEAN BECKER: Now, Al, let's talk about that a second. You know, I'm an old guy, I smoke Marlboros for way too long. It's getting quite difficult for me to smoke pot. And for many folks, you know, those vaporizers can be neat, but they're not—you can't use them everywhere you go. And it would be nice to have a product where you knew the effect—like so many of these cookies and other pastries so to speak. You never quite know what's in there, right?

AL COLES: Exactly, and that's the thing that we sell that we know exactly what it is. And also because it's in—it's not an alcohol product, but there is an alcohol base in there. And what the alcohol does is allow it to absorb fast. So rather than waiting a half an hour two hours, in some cases, for the effects, it comes on in fifteen minutes. And that also allows you to know the experience, know what you're getting quickly; and if you need to increase it, you can increase it precisely and proportionally.

And what this allows for again is just the real use of a medicine and not guessing what's gonna happen. We know what’s gonna happen every time.

DEAN BECKER: Once again, we're speaking with Mr. Al Coles, CBD Science. Now Al, you guys are currently dispersing this through three dispensaries, but you have plans for further growth?

AL COLES: Absolutely. We hope to spread out through all of California. That's where we're currently licensed under the current regs; but it's certainly possible for other opportunities throughout the US. And right now this is our first real public announcement, we've been in development for over two years and we're interested in gathering of the dispensaries and spreading the word.

DEAN BECKER: Okay, well Al if you would, share your website with the listeners where they can learn more.

AL COLES: Yes, the first one is www.4altacalifornia.com, that is the product information on the three different remedies, that I'd like to speak a little bit about if you have time; and the second website that you should be familiar with is www.cbdscience.com.
DEAN BECKER: There's a company out of Great Britain called GW Pharmaceuticals, it's been manufacturing an oral extract—50% THC, 50% cannabinoids—for years now. It's legal in several countries around this planet, and it's called "Sativex." It costs $140 per quarter ounce. I'm told these products from CBD Science cost about one fourth that amount.

Closing it out here, I wanted to thank the good folks at Texas Southern University—Florence Coaxum in particular—for inviting me to speak at their recent conference on incarceration and post-traumatic stress disorder.

And as always, I remind you that there is no truth, justice, logic, no reason for this drug war to exist. Please do your part to end this madness. Visit our website endprohibition.org.

Prohibido istac evilesco!

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.

[Music Outro]