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 Subject :Sonoma County to regulate Dispensing Collectives... Monday, 19 July 2010 
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Forum : In The News
Topic : Sonoma County to regulate Dispensing Collectives.

Sonoma County: Pot clubs must seek operating permit

 

By BRETT WILKISON
THE PRESS DEMOCRAT

Karen Kissler is the owner of a cozy, Tuscan-styled medical marijuana dispensary with an indoor granite fountain, plush black leather sofas and azure blue walls.

One thing her shop outside Santa Rosa city limits doesn't have, though, is a legal license to operate from Sonoma County authorities.

Alternatives, A Health Collective opened on Santa Rosa Avenue in February, two months after the county's 2007 ordinance on pot dispensaries was struck down by a Sonoma County Superior Court judge.

But last month, a state appellate court sided with the county and temporarily reinstated the ordinance until a final ruling, which isn't expected for several months.

Until then, Kissler and at least five other dispensaries that have been operating without permits are under new orders issued by the county last week. They must either cease operations immediately or begin applying for a costly permit that could make them legal.

Kissler, like several other dispensary operators, has applied for a permit, subjecting her shop to rules that she believes need a major overhaul.

“If you comply with the ordinance and make efforts from inside (the legal system) to change it, it's much more effective,” she said.

At least three other unpermitted dispensaries also have filed applications for a use permit, two of which were in the system before the recent appellate court decision, county officials said.

Enforcement actions against those dispensaries, the Starbuds Cannabis Club outside of Santa Rosa, Riverside Wellness in Guerneville and Redwood Herbal Alliance inLarkfield, will be held off as long as the owners “diligently pursue” a permit, said Pete Parkinson, director of the county's Permit and Resource Management Department.

Parkinson added, however, that the stop-business order is immediate and that: “We can take enforcement actions at any time.”

He said the county's approach is to evaluate each unpermitted dispensary's response on a case-by-case basis, considering whether they could ultimately meet the zoning requirements, or if they present health and safety concerns.

At least one of the unpermitted dispensaries, Native Herbs, outside of Cotati at Stony Point Road and Highway 116, appears to have closed. County officials said the dispensary was located on land zoned for agriculture and could not have been permitted for that reason. Dispensaries are limited to areas zoned for commercial or limited-commercial uses.

Two other dispensaries, Marvin's Gardens Cooperative in Guerneville and the Green House Wellness Center outside Sebastopol, are applying for permits, according to their representatives.

The three-page application requires extensive documentation, including maps and design drawings of each site, setbacks from other uses in the area, including schools, homes and conventional smokeshops, descriptions of security and patient-privacy rules and indemnification of the county in the event of any lawsuit.

Basic cost for the permit application was $4,764 last week, but has since gone up with other county fees to $5,805, plus $1,500 to $2,000 in referral fees.

For Marvin's Gardens, the dispensary that touched off the legal battle with the county less than a year ago, that price tag is a bitter pill to swallow.

“The first time they took our money and didn't give us a permit,” said Shawn Marvin Pina president of the Guerneville dispensary.

Formerly in Rio Nido, the dispensary sued the county in October after the county sent it a stop-business notice. Dispensary representatives said they were denied a permit and later refunded only half their $8,000 application fee. County officials say the dispensary had claimed that another dispensary was allowed to transfer its permit to Guerneville shop.

Pina, the cooperative's president, said the dispensary is applying for a permit even though he considers the current ordinance “unfair and unjustified.”

He would not say specifically what he found objectionable about the ordinance, but added that “dispensaries have less problems than bars. What have they got that shows there's crime going up? What's the big deal?”

County officials said previously that they had received numerous complaints about the unpermitted dispensaries, including issues with increased traffic and security concerns. However, only four complaints have been lodged with the Permit and Resources Management Department, a code enforcement official said this week.

One was from a parent who was upset with the relocation of a bus stop away from one of the Guerneville dispensaries. Another was from a Sonoma County Sheriff's detective concerned about what he thought was faulty wiring at the Starbuds facility. The detective made the observation while investigating an April 2 strong-arm robbery at the facility.

The other two were general complaints from a pair of competitors, including Peace in Medicine Healing Center inside the city of Sebastopol and OrganiCann, the Todd Road dispensary that is the only medical marijuana dealer operating under a county permit.

Those complaints have prompted some bitter feelings in the small circle of local medical marijuana shop operators.

“I believe that money is fouling the issue here,” said Jon Humphrey, chief executive of the Green House Wellness Center.

Among all the operators, Kissler has perhaps the most specific beef with the county's ordinance. She says her current number of clients is up to 2,000, but under the county's rules, because of the type of commercial zoning at the small strip-mall where she does business, she is only allowed to have 300 customers.

Kissler requested an exemption from that cap, adding another expense to the $5,500 permit application she filed last week. But if she doesn't get the exemption from the county, she'll likely be forced to split her clients with a spin-off shop or relocate altogether.

“It's completely arbitrary,” she said the of the client limit.

County officials said the cap is in place to ensure compatibility with nearby residential areas. But Kissler, an attorney, said her whole intention in getting into the medical business was to add an air of respectability to the needs of the many chronically sick and terminally ill patients who use her product.

“I'm about as non-new-agey as you can get,” she said. The current ordinance is so rigid in certain areas and vague in others, including security measures, she and others said, that it scares away legitimate dispensary operators and thereby limits patients' access to what is often a last-ditch health care option.

“We think that the county did not do its homework,” Kissler said. “I'm in favor of having an ordinance that better reflects our patients' needs.”

 

 Subject :Respect people and their points of view.. Friday, 16 July 2010 
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Forum : Politics
Topic : Respect people and their points of view

Politics can often be a tricky and personal area. We ask that all comments and posts be respectful and we ask that patients have open minded discussions. Any disrespectful or volatile discussion will be removed and patients who provoke others may be removed from the forums. Please do not make us act like your mother:).

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 Subject :CCO Safety and Cultivation Best Practices.. Friday, 16 July 2010 
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Forum : Cultivation Station
Topic : CCO Safety and Cultivation Best Practices

The following are some basic standards that those who cultivate for our organization are required to follow. These rigid standards ensure your medicine supply is of the highest quality.

 

Public Safety Standards:

1. All cultivation areas must be dedicated to only growing cannabis 
 medicines. If the facility is a home, the area used for cultivation must 
 has appropriate barriers and be restricted from the public. Only authorized 
 patients, caregivers, or qualified staff should be allowed in the restricted 
 garden area.

2. Intrusion alarm system should be implemented on facilities of 
 collective cultivation where more than one patient garden is present or 
 where medicine for patient use is stored. This will help deter criminal 
 activity to the site and promote safety. Alarm system should have 
 appropriate line supervision from a reputable security company.

3. All electrical needs for the cultivation area must be in accordance 
 with local electrical codes.

4. Storage of medicine should be in an appropriate and secure area of the 
 facility.

Good Cultivation Practices: (All patients cultivating medicine must sign a commitment to follow these standards).

Ø Make the garden area a clean work environment. Gardens and grow rooms should be kept cleaned and sanitized prior to cultivation. The best defense is prevention. By eliminating unwanted biological agents from the space prior to planting, you will reduce the need for harsh, potentially hazardous, chemical solutions later on. Surfaces should be kept dust free; floors should be swept or vacuumed regularly. Tools should be sanitized between uses. Plants should be inspected frequently for signs of infestations or chemical imbalance. Regular cleaning is a top priority for medical gardens.

Ø Wash up before and after working in grows areas. Researchers have discovered that the most common pathogens transmitted in cannabis are chloroform and E. Coli bacteria. The transfer of these bacteriological agents can be greatly reduced by washing your hands before and after working in a garden.

Ø Use proper safety equipment when handling medicine. Use gloves and facemasks when handling medicine intended for direct consumption. It is good practice to have a change of clothes, including shoes, which are designated for use in the garden. This helps avoid bringing in pests and contaminants from the outside. If you wanted to go a step further, you can wear protective Tyvek suits, hairnets, protective shoe booties, and nitrile gloves. This safety equipment can be purchased relatively cheap at medical supply stores and safety equipment outlets.

Ø Keep unnecessary elements out of the medicine areas. Gardens and grow rooms should not be high traffic areas. People not directly working in the garden should stay out, as they may introduce contaminants. Keep children and pets out of garden areas at all times. Grow rooms are not good storage areas and should be kept clear of clutter. Do not eat in the garden area. Do not smoke tobacco products in the garden. The smoke from tobacco (including blunts) contains unnatural toxins, which can build up upon the foliage. This can harm plants and possibly patients. Be aware when working around ventilation intakes, as harsh chemicals and cleaners may be drawn in through the system and contaminate the grow. Use filters when needed and seal the room well to control pests

Ø Use safe cleaning products and plant maintenance additives. Since harsh chemicals can damage plant vitality and accumulate inside plant tissue, they should be used sparingly when cultivating medicine. There are many safe and effective fertilizers, pesticides & cleaning agents on the market. Using natural cleaning solutions, such as diluted hydrogen peroxide, are often less expensive and more effective than brand name cleansers. Even natural citrus cleaners can contain petroleum bases that can damage both plants and equipment. Isopropyl alcohol works well on surfaces, utensils and equipment. The use of organic pesticides and nutrients are strongly encouraged as they may be easily flushed and come from natural sources. A simple solution of organic soap can usually take care of small infestation problems if caught early enough. This is why it is important that every plant in the garden be inspected regularly to catch any issues that may arise before they become problematic. Be aware of every product used during cultivation, its possible effects upon human health and document how it was applied. Ensuring patient safety should be the most important factor when selecting a product to use in medical gardens. If unsure, ask a professional for help.

Ø Always flush with plenty of clear water before harvesting. It is important to clean out as much fertilizer and plant additives that may have accumulated in the plant tissue prior to harvest. Properly flush each plant with the appropriate volume of water. Many resources are available for proper flushing techniques.

Ø Handle finished medicinal flowers and byproducts (trimmings) with extreme care. Cure medicine in a sanitized, well ventilated drying area. Adjust the temperature, humidity and airflow to minimize the risk of mold. Whether trimming before or after the drying process, it is important to have clean hands, tools, storage containers and work surfaces. Use gloves, facemasks, and dedicated clothing, as if working in the garden. Handle trimmings intended for concentrates, edibles, or other cannabis based products, with the same care as finished flowers. Waste should be removed immediately.

Ø Be proactive. The most dangerous element of growing medical cannabis is human error on part of the cultivator. Pathogens do not magically appear; they were either present in the room before planting, or introduced later through improper practices. Inspect and sanitize the garden frequently. Keep good notes and do not be afraid to ask a professional when situations arise. Most products related to growing have contact numbers on them to reach the company directly. If unsure if a product is appropriate for your needs, call and ask a representative.

 

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 Subject :Cannabis and Stress Anxiety.. Friday, 16 July 2010 
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Forum : Stress/Anxiety
Topic : Cannabis and Stress Anxiety

In recent IDMU surveys, relaxation and stress relief were overwhelmingly the most commonly perceived benefits of cannabis use.  However, the Department of Health identifies panic attacks and anxiety as effects of acute cannabis intoxication, particularly among naive users, in justifying the refusal of the UK Government to permit the prescribing of cannabis.
Recent advances in fundamental cannabinoid research have been interpreted as indicating a common modality of action of cannabis and opiate drugs, in that naloxone (an opiate antagonist) blocks cannabinoid-induced dopamine release in the limbic system (a primitive brain structure associated with control of emotion and mood) [i] and the a cannabinoid antagonist administered to rats, pretreated with a powerful synthetic cannabinoid agonist, can precipitate corticotrophin releasing factor (CRF) which is held to be the mechanism responsible for mediating the psychological aspects of drug withdrawal symptoms, and leading to anxiety-type behaviours [ii] .  This was interpreted as demonstrating a cannabis withdrawal syndrome, however the potency of the synthetic cannabinoid used was many times that of THC, and the administration of an antagonist (blocker) would not effectively mimic the gradual decrease in plasma THC which occurs with cessation of normal use.  The fact that a potent cannabis blocker caused anxiety symptoms in rats would be consistent with a general diminution of anxiety levels arising from cannabis use.

Laurie [iii] reported that in a few cases 'anxiety, which may approach panic, often associated with a fear of death or an oppressive foreboding is infrequently seen, usually giving way to an increasing sense of calmness... to euphoria'.  Grinspoon refers to the initial state as a 'happy anxiety' where the experience is internally redefined as pleasurable.  Rosenthal et al [iv] report that panic reactions and anxiety are rare, and most commonly found with overdose (particularly from oral preparations), in na¹ve users, or in those who do not like the effects of marijuana, and attributed the incidence of anxiety reports with Marinol (dronabinol - pure THC) to the lack of CBD within the preparation.  Mikuriya [v] considered that 'the power of cannabis to fight depression is perhaps its most important property'.  Patients were reported to self-medicate with cannabis rather than use benzodiazepines as the former produced less dulling of mental activity.  The authors cited one study where marijuana was found to increase anxiety in na¹ve users, but to decrease anxiety in experienced users, and another of 79 psychotics who used marijuana recreationally and reported less anxiety, depression, insomnia or physical discomfort [vi] , and concluded that natural marijuana - containing CBD and THC - appeared more effective than THC alone in treating depression, and that patients suffering stress as a result of pain or muscle spasms would be most likely to be helped by the drug.  They differentiated the use of cannabis to cope with everyday life stresses from the use of benzodiazepines in treating 'severe anxiety disorders' with an organic aetiology.

Bello [vii] in a passionate treatise on the benefits of cannabis for physical and mental health, likened the anxiolytic effect of marijuana to a state of relaxed alertness brought on by 'balancing' the autonomic nervous system.

Explanations of the panic and anxiety experienced by some na¹ve users exposed to cannabis would include 'set and setting' i.e. a drug taken in the course of a laboratory experiment would provide different expectations of an experience to an informal party or gathering of friends, secondly the increase in heart rate can be interpreted by some older users as a heart attack and cause panic attacks [viii] , this 'tachycardia' is normally associated with a reduction in blood pressure, the combined effect is analogous to changing down a gear in a motor vehicle.  Some individuals may be more susceptible to the effects of cannabis than others, and those whose initial experience is unpleasant may be more likely to discontinue use of the drug.  By contrast, many first-time users fail to notice the influence of the drug.

Thompson & Proctor [ix] , treating withdrawal conditions, noted the synthetic cannabinoid pyrahexyl to produce significant increases in alpha brain waves, indicating increased relaxation, and Adams reported similar results [x] .  However Williams et al found no significant increase in alpha activity either with parahexyl or smoked marijuana [xi] .

Davies et al [xii] , in a study of cancer patients, considered the management of stressful patients to have been improved by oral THC.  However a study of intravenous THC used as a premedication for oral-facial surgery [xiii] found that patients showed pronounced elevation of anxiety, and considered noxious stimuli to be more painful.  Mechoulam [xiv] considered a number of synthetic cannabinoids to be worthy of investigation as potential sedative-relaxants.

In laboratory animals, the cannabinoid receptor has been linked to modulation of emotional behaviour [xv] , reinforcement [xvi] , learning [xvii] and memory [xviii] [xix]   Musty [xx] compared the effects of THC, CBD (cannabidiol) and diazepam (valium) on anxiety-related behaviours in mice.   THC produced similar reductions in anxiety behaviours to diazepam, however the effect of CBD was more pronounced than either in measures of shock-avoidance, grooming and reduction of delerium tremens in alcohol-withdrawn mice.  Both THC and CBD produced dose-related reductions in ulcer formation in stressed mice.  However in all tests the CBD dosages used were higher than THC dosages.

Mechoulam reviewed studies of Nabilone (synthetic cannabinoid) on anxiety, finding two studies which suggested a superior effect on anxiety, mood and concomitant depression, whereas two other studies found little or no effect.  Benowitz & Jones [xxi] reported initial tachycardia and hypertension in volunteer subjects administered up to 210mg THC per day, but found development of tolerance to tachycardia and CNS effects over the 20 day experiment, with blood pressure reduced and stabilised at around 95/65.  Fabre & McLendon [xxii] reported a dramatic improvement in anxiety in the nabilone-treated group compared to placebo.  Nakano et al [xxiii] reported anti anxiety effects of nabilone and diazepam in a controlled trial of experimentally-induced stress, but was unable to conclude which was more effective due to differences in dosage and metabolism.  Hollister [xxiv] reported these and other nabilone studies [xxv] indicating significant anti-anxiety effects of low doses, and commented on the scarcity of studies of potential anti-anxiety effects of cannabinoids.

Post-Traumatic Stress Disorder:  I am unaware of any controlled scientific studies in published journals which investigate the use of cannabis as a treatment option for post-traumatic stress disorder, although several studies of this condition make reference to cannabis use by patients.  In a study of female drug clinic patients with histories of post-traumatic stress disorder following physical or sexual abuse, Gil-Revas et al [xxvi] reported "contrary to expectation, PTSD is not associated with relapse to drug use".  Clark et al [xxvii] found PTSD to be a common diagnosis among a group of alcoholic adolescents, who also showed high rates of cannabis and hallucinogen use, considering the relationship to reflect a comorbid disorder.  DeFazio et al [xxviii] studied Vietnam veterans, finding a higher incidence of PTSD symptoms among combat, compared to non-combat groups, the relationship to cannabis use is unclear, but may reflect a coping strategy, where the use of marijuana by US troops during combat has been widely-documented, which typically ceased upon return to civilian life.

Cannabis and Depression

Depression is a term used to describe a variety of different disorders characterised by lowering of mood, disinterest in ones surroundings or condition, fatigue, and loss of appetite and/or personal neglect.  For most people, depression is a passing mood, for others it is a debilitating condition with severe emotional and physical symptoms.  Only when depression is serious is it normally considered a psychiatric disorder requiring treatment.  Most drug treatments for clinical depression involve use of tricyclic antidepressants (e.g. amitriptyline), monoamine oxidase inhibitors (e.g. isocarboxazid) or more recently fluotexine (prozac), both of which boost levels of brain catecholamines (stimulant neurotransmitters including noradrenalin or serotonin). 

Cannabis products have long been considered to be effective in the treatment of depressive disorders, in 1845 it was recommended for melancholia (with obsessive rumination) and mental disorder in general [xxix] .  In 1947 Stockings [xxx] found improvements in 36 out of 50 depressed mental patients treated with a synthetic cannabinoid.  Grant et al [xxxi] in a US population study, commented "cannabis might be used to self-medicate major depression."  Schnelle et al [xxxii] found depression to be the most common reason for self-medication in a study of German-speaking medicinal cannabis patients.

In a case study Bolls [xxxiii] reported a case of post-natal depression successfully treated by a large oral dose (4g of alcoholic cannabis tincture) and counselling.  The subject reported anxiety at the peak of the drugs effect, however the study involved a single case, was not controlled under current scientific methodology, and it could not now be concluded whether any recovery was due to the drug, the psychotherapy, or would have occurred in any event.  Conversely Payne [xxxiv] reported a case history where cannabis use was considered to worsen the patientòs mood disorder.

Kotin et al [xxxv] , in a double-blind experiment, found no effect on moderate to severe depression from relatively high doses (0.3mg/kg) of THC.  Grinspoon considered cannabinoids to be of promise where depression is secondary to some life event (reactive depression) rather than a primary diagnosis, but did not consider general optimism about such treatment to be justified by the state of knowledge in 1977.

Regelson et alia [xxxvi] reported a number of significant effects in a controlled study of THC in terminal cancer patients, including a reduction in depression, greater emotional stability, more self-reliant/less dependent, less suspiciousness, increased forthrightness, less apprehension, more normal level of control and more tranquil/relaxed, however two patients who discontinued the study reported fear and anxiety, confused thinking and dissociation.  The authors commented that such effects would appear to be confined to a susceptible population.

Grinspoon [xxxvii] considered some patients who fail to respond to traditional antidepressant drugs, or who find the side-effects of these unbearable, to have been helped by illicit marijuana use, quoting 3 case studies all involving long histories of severe clinical depression, all treated unsuccessfully with all types of antidepressive medication, and all now living normally through use of cannabis, twice daily in one case, on re-appearance of symptoms in the others, each attributing the improvement to greater self-insight, a reduction of a negative self-image, and/or a general euphoria arising from cannabis intoxication.

Several recent studies have highlighted the association between depression, conduct disorder and substance  (including cannabis & alcohol) abuse [xxxviii] .  Rey et al [xxxix] considered this to represent "a malignant pattern of comorbidity that may lead to negative outcomes".  Lynskey et al [xl] noted major depression to be a correlate of cannabis dependence, but noted "genetic risk factors are important determinants of risk of cannabis dependence among men". Bovasso [xli] , following a large-scale longitudinal survey of depressive patients,  considered cannabis use to be a risk factor for depressive symptoms:  "In participants with no baseline depressive symptoms, those with a diagnosis of cannabis abuse at baseline were four times more likely than those with no cannabis abuse diagnosis to have depressive symptoms at the follow-up assessment, after adjusting for age, gender, antisocial symptoms, and other baseline covariates. In particular, these participants were more likely to have experienced suicidal ideation and anhedonia during the follow-up period. Among the participants who had no diagnosis of cannabis abuse at baseline, depressive symptoms at baseline failed to significantly predict cannabis abuse at the follow-up assessment." In a case study of a brain-damaged patient, Payne [xlii] noted "The impact of cannabis use in this individual appeared to have a detrimental effect on his mood."

In a survey of young Austrialian adults, Degenhardt et al [xliii] concluded "Cannabis use did not appear to be directly related to depression or anxiety when account was taken of other drug use. However, the association between heavier involvement with cannabis use and affective and anxiety disorders has implications for the treatment of persons with problematic cannabis use." Dhossche et al [xliv] noted "Detection of alcohol, cocaine, or cannabis in about 40% of suicides supports the clinical practice of discouraging consumption of these substances in depressed patients".  However  in a clinical trial of synthetic cannabinoids (CB1-agonists) Tramer et al found these enhanced mood among cancer  patients: "In selected patients, the cannabinoids tested in these trials may be useful as mood enhancing adjuvants for controlling chemotherapy related sickness." [xlv]   Nunn et al [xlvi] reported "Neither anxiety or depression scores were higher in cannabis users...", and Dumas et al [xlvii] reported "The co-occurrence of cannabis use and schizotypal traits appeared to be independent of anxiety and depression dimensions".

However Aharonovitch et al [xlviii]   postulated "the self-medication hypothesis  of substance abuse...  that drug abuse is driven by an attempt to alleviate specific psychological distress".  Abraham & Fava [xlix]   studying the order of onset of depression and substance abuse  in an attempt to resolve the "cause or self-medicationò question, reached no conclusions concerning cannabis alone, but noted "Among polydrug-dependent patients, each drug abused followed the onset of depression, except for LSD, which coincided with the onset of depression." In a study of patients with bipolar disorder (manic depressive psychosis),  Strakowski  et al [l] found "The duration of alcohol abuse during follow-up was associated with the time patients experienced depression. The duration of cannabis abuse was associated with the duration of mania."  In schizophrenia patients, Hambrecht & Hafner [li]   identified three subtypes of patient in relation to cannabis use: "Group 1 might suffer from the chronic deteriorating influence of cannabis reducing the vulnerability threshold and/or coping resources. Group 2 consists of individuals which are already vulnerable to schizophrenia. Cannabis misuse then is the (dopaminergic) stress factor precipitating the onset of psychosis. Group 3 uses cannabis for self-medication against (or for coping with) symptoms of schizophrenia, particularly negative and depressive symptoms. These patients probably learn to counterbalance a hypodopaminergic prefrontal state by the dopaminergic effects of cannabis."  In an American epidemiological study of cannabis use, dependence and co-morbidity, Grant & Pickering [lii] concluded "cannabis might be used to self-medicate major depression."

A Canadian study of self-medicating cannabis users by Ogborne  et al [liii] reported patients used for a variety of conditions including: "HIV-AIDS-related problems, chronic pain, depression, anxiety, menstrual cramps, migraine, narcotic addiction as well as everyday aches, pains, stresses and sleeping difficulties."  In a similar German study, Schnelle et al [liv]   found "The most frequently mentioned indications for medicinal cannabis use were depression (12.0%), multiple sclerosis (10.8%), HIV-infection (9.0%), migraine (6.6%), asthma (6.0%), back pain (5.4%), hepatitis C (4. 8%), sleeping disorders (4.8%), epilepsy (3.6%), spasticity (3.6%), headache (3.6%), alcoholism (3.0%), glaucoma (3.0%), nausea (3.0%), disk prolapse (2.4%), and spinal cord injury (2.4%)."

In a learned review, Williamson & Evans [lv] reported "Not all the observed effects can be ascribed to THC, and the other constituents may also modulate its action; for example CBD reduces anxiety induced by THC. A standardised extract of the herb may be therefore be more beneficial in practice and clinical trial protocols have been drawn up to assess this." and concluded "Patients taking the synthetic derivative nabilone for neurogenic pain actually preferred cannabis herb and reported that it relieved not only pain but the associated depression and anxiety."

In November 2002, the British Medical Journal published the results of three separate longitudinal ("cohortò) studies into mental health outcomes of adolescent cannabis users.

(a)          Swedish Conscripts ¸ a cohort study by Zammitt et al [lvi] of 50,000 Swedish male conscripts in 1969 were followed up at intervals between 1970 and 1996.  Of the 5391 subjects who had ever used cannabis, 73 had developed schizophrenia (1.4%) compared to 215 out of 36429 subjects (0.6%) who had never used (or denied using) the drug.  The study suggested that all cannabis users are 50% more likely to develop schizophrenia, and regular users three times as likely, after controlling for social factors including use of other drugs.  However the study had data on cannabis use only at the outset of the study, and the control cohort would not have excluded subjects who subsequently started to use cannabis after age 18-20, or users of cannabis who denied using the drug.  It is unclear whether  the rigour in assessing the mental health history of control subjects matched that for cannabis-using subjects. 

(b)          Australian Students ¸ A seven year follow-up study of 1601 secondary school students in Australia by Patton et al [lvii] found that weekly or more frequent use of cannabis during adolescence predicted a two-fold increase in later development of depression and anxiety, with young women being at particular risk, although for young men the effect was not statistically significant, if anything they showed lower rates of depression than controls.  Young women were statistically 60% more likely to develop depression than men in the absence of cannabis use. The authors found no relationship between adolescent anxiety and depression and later cannabis use, which they interpreted as excluding the "self-medicationò hypothesis.

(c)          New Zealand Birth Cohort ¸ A longitudinal study by Arsenault et al [lviii] of 1037 individuals born in 1972-3 was followed up at ages 11, 15, 18 and 26.  They found cannabis use by age 15 (n=29) to be associated with a four-fold increase in the likelihood of developing schizophreniform symptoms by age 26 (p<.05), although use by age 18 (n=236) showed no significantly increased risk.  A weakly significant association was found between cannabis use by age 18 and depressive symptoms by age 26, the odds ratio falling closer to the boundary of significance when the data was controlled for pre-existing psychopathologies and use of other drugs.  Again, no relationship was found between adolescent symptomatology and later cannabis use, and the authors rejected the "self-medicationò hypothesis.

It may well be that common factors predispose an individual both to schizophrenia and to early use of cannabis, particularly in a country like Sweden with a very strong prohibitionist enforcement policy and anti-drug social attitudes, where early cannabis use may be considered more "deviantò than in countries with more tolerant social attitudes to the drug.

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 Subject :Some facts on cannabis and aging.. Friday, 16 July 2010 
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Posts: 19
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Forum : Aging
Topic : Some facts on cannabis and aging

CANNABIS AND AGING

Cannabis has been found to help many patients suffering from conditions that afflict older patients, including arthritis, chronic pain, cancer, Alzheimer's disease, diabetes, and spasticity associated with such diseases as Parkinson's.

Cannabis and Arthritis

More than 31 million Americans suffer from arthritis. There are two common types of arthritis, rheumatoid arthritis and osteoarthritis, but both affect the joints, causing pain and swelling, and limiting movement. Rheumatoid arthritis is caused by a malfunction of the immune system. Instead of fighting off intruders such as bacteria or viruses, the body attacks the synovial membranes, which facilitate the movement of joints, eventually destroying cartilage and eroding bones. Rheumatoid arthritis is most common among the aged, whose immune systems are no longer as robust or efficient. Osteoarthritis, or arthritis of the bones, is also found primarily among the elderly, whose cartilage has been worn away through use. Arthritis may also manifest as chronic inflammation of the joints as the result of injuries.

Recent research is accumulating evidence that cannabis therapies are effective for arthritis and the other rheumatic and degenerative hip, joint and connective tissue disorders. Since these are frequently extremely painful conditions, the ability of cannabis to combat chronic pain makes it useful for that aspect, both on its own and as an adjunct therapy that enhances the efficacy of opiod painkillers. The use of cannabis as a treatment for musclo-skeletal pain in western medicine dates to the 1700s.[12-13]

But cannabis has also been shown to have powerful immune-modulation and anti-inflammatory properties,[14-17] indicating it may treat chronic inflammatory diseases directly. In fact one of the earliest records of medical use of cannabis—a Chinese text dating from ca. 2000 BC—notes that cannabis is effective in treating rheumatism, suggesting that ancient societies long ago recognized its anti-inflammatory and analgesic properties.[18]

Modern research on cannabidiol (CBD)—one of the non-psychoactive components of cannabis—has found that it suppresses the immune response in mice and rats that is responsible for a disease resembling arthritis, protecting them from severe damage to their joints, and markedly improving their condition.[19-20]

Human studies have shown cannabis to be an effective treatment for rheumatoid arthritis, and it is one of the recognized conditions for which many states allow legal medical use. Cannabis has a demonstrated ability to improve mobility and reduce morning stiffness and inflammation. Research has also shown that patients are able to reduce their usage of potentially harmful Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) when using cannabis as an adjunct therapy.[21-22]

Medical researchers investigating Cannabidiol at Hebrew University in Jerusalem discovered an acid with potent anti-inflammatory action comparable to the drug indomethacin, but without the considerable gastrointestinal side effects associated with that drug.[23]

In addition, when the body metabolizes tetrahydrocannabinol (THC,  one of the primary components of cannabis) it produces a number of related chemicals. At least one of these metabolites has anti-inflammatory and pain-relieving effects. By modifying this metabolite, researchers at the University of Massachusetts Medical Center have produced a synthetic carboxylic acid known as CT-3 (also called DMH-11C, chemical name dimethylheptyl-THC-11 oic acid), which is more powerful than the natural metabolite and can be given in smaller doses. Animal tests found CT-3 effective against both chronic and acute inflammation; it also prevented destruction of joint tissue from chronic inflammation. The long safety record of marijuana (no one has ever died of an overdose) and the discovery that a metabolite with the desired anti-inflammatory effect is produced in the body when marijuana is used, strongly suggest that safe and effective anti-inflammatory drugs may be developed from cannabinoids.[24]

In addition, CT3 has demonstrated analgesic effects in animals. In some cases, the dose-dependent effect of THC was equivalent to morphine, but with a much greater duration of action.[25-26] In contrast to the NSAIDs commonly prescribed arthritis sufferers, CT3 did not cause ulcers at therapeutically relevant doses. Moreover, it does not depress respiration, produce dependence, induce body weight loss or cause mutations. Studies on its mechanism of action are currently underway, and cytokine synthesis is one of the pathways being investigated.[27]

Cannabis may also help combat rheumatoid arthritis by way of its established immune-modulation properties.[28] Rheumatoid arthritis is characterized by dysregulation of the immune system in response to an initial infection or trauma. Over-activity of the immune system's B-cells causes antibodies to attack and destroy the synovial tissues located in the joint.

The immuno-modulatory properties of a group of fats found in cannabis, known as sterols and sterolins, have been used as natural alternatives to conventional rheumatoid arthritis treatments, which typically employ highly toxic drugs to either suppress the entire immune response of the body or to palliate pain and the inflammatory process without correcting the underlying immune dysfunction.

Cytokines play a role in either fueling or suppressing the inflammation that causes damage in rheumatoid arthritis and some other diseases. The release of selected cytokines is impaired by cannabis, but the findings differ by cell type, experimental conditions, and especially the concentration of the cannabinoids examined.[29-32] A sterol/sterolin combination has been experimentally demonstrated to reduce the secretion of the pro-inflammatory cytokines controlled by the TH2 helper cells and to increase the number of TH helper cells that regulate the secretion of antibodies from the B cells. This selective activation and inhibition of the immune system is effective in controlling the dysfunctional auto-immune response.

Similarly, another non-psychoactive cannabinoid, ajulemic acid, has been found by UMass Medical Center researchers to reduce joint tissue damage in rats with adjuvant arthritis.[33] Tests on human tissue done in vitro showed a 50% suppression of one of the body chemicals (interleukin-1beta) central to the progression of inflammation and joint tissue injury in patients with rheumatoid arthritis.[34]

Cannabis and Chronic Pain

Many older patients suffer from persistent and disabling pain, which can have numerous and sometimes multiple causes. These include cancer; arthritis and other rheumatic and degenerative hip, joint and connective tissue disorders; diabetes; AIDS; sickle cell anemia; multiple sclerosis; defects or injuries to the back, neck and spinal cord; and severe burns. Pain is not a primary condition or injury, but is rather a severe, frequently intolerable symptom that varies in frequency, duration, and severity according to the individual. The underlying condition determines the appropriate curative approach, but does not determine the proper symptom management. It is the character, severity, location and duration of the pain that determines the range of appropriate therapies.

For patients in pain, the goal is to function as fully as possible by reducing their pain as much as possible, while minimizing the often debilitating side effects of the pain therapies. Failure to adequately treat severe and/or chronic pain can have tragic consequences. Not infrequently, people in unrelieved pain want to die. Despair can also cause patients to discontinue potentially life-saving procedures (e.g., chemotherapy or surgery), which themselves cause severe suffering. In such dire cases, anything that helps to alleviate the pain will prolong these patients' lives.

Cannabis can serve at least two important roles in safe, effective pain management. It can provide relief from the pain itself (either alone or in combination with other analgesics), and it can control the nausea associated with taking opiod drugs, as well as the nausea, vomiting and dizziness that often accompany severe, prolonged pain.

Opioid therapy is often an effective treatment for severe pain, but all opiates have the potential to induce nausea. The intensity and duration of this nausea can cause enormous discomfort and additional suffering and lead to malnourishment, anorexia, wasting, and a severe decline in a patient's health. Some patients find the nausea so intolerable that they are inclined to discontinue the primary pain treatment, rather than endure the nausea.

Inhaled cannabis provides almost immediate relief for this, with significantly fewer adverse effects than orally ingested Marinol. Inhalation allows the active compounds in cannabis to be absorbed into the blood stream with greater speed and efficiency. It is for this reason that inhalation is an increasingly common, and often preferable, route of administration for many medications. Cannabis may also be more effective than Marinol because it contains many more cannabinoids than just the THC that is Marinol's active ingredient. The additional cannabinoids may well have additional and complementary antiemetic qualities. They have been conclusively shown to have better pain-control properties when taken in combination than THC alone.

Research on cannabis and pain management

Cannabis has historically been used as an analgesic,[35-36] and patients often report significant pain relief from marijuana.[37-42] Some of the most encouraging clinical data on the effects of cannabinoids on chronic pain are from studies of intractable cancer pain and hard-to-treat neuropathic pain.[43-44]

After reviewing a series of trials in 1997, the U.S. Society for Neuroscience concluded that "substances similar to or derived from marijuana could benefit the more than 97 million Americans who experience some form of pain each year."[45]

A 1999 study commissioned by the White House and conducted by the Institute of Medicine recognizes the role that cannabis can play in treating chronic pain. "After nausea and vomiting, chronic pain was the condition cited most often to the IOM study team as a medicinal use for marijuana."[46]

The study found that "basic biology indicates a role for cannabinoids in pain and control of movement, which is consistent with a possible therapeutic role in these areas. The evidence is relatively strong for the treatment of pain and intriguingly, although less well established, for movement disorder." According to the report, a number of brain areas that have an established role in sensing and processing pain respond to the analgesic effect of cannabis, such that cannabinoids have been used successfully to treat cancer pain, which is often resistant to treatment with opiates.

The Report further notes that cannabinoids serve as an anti-inflammatory agent, and so have therapeutic potential in preventing and reducing pain caused by the swelling of body tissues (such as arthritis).

In addition to its analgesic properties, the Report indicates that cannabis, like its synthetic cousin Marinol, can help treat the nausea often induced by opiate therapy, especially when other antiemetics prove ineffective. In short, the IOM Report recognizes the potential benefits of cannabis for certain patients, including:

· Chemotherapy patients, especially those being treated for mucositis, nausea, and anorexia.

· Postoperative pain patients (using cannabinoids as an opioid adjunct to reduce the nausea and vomiting).

· Patients with spinal cord injury, peripheral neuropathic pain, or central post-stroke pain.

· Patients with chronic pain and insomnia.

· AIDS patients with cachexia, AIDS neuropathy, or any significant pain problem.

Britain's House of Lords reached similar conclusions and called for legalized cannabis by prescription.[47]

Several studies have found that cannabinoids have analgesic effects in animal models, sometimes equivalent to codeine.[48-52] Cannabinoids also seem to synergize with opiods, which often lose their effectiveness as patients build up tolerance. One study in rats found morphine was 15 times more active with the addition of a small dose of THC. Codeine was enhanced on the order of 900 fold.[53]

In 1990, researchers conducted a double-blind study comparing the antispasmodic and analgesic effects of THC, oral Codeine, and a placebo on a single patient suffering from a spinal cord injury.[54] Their findings confirmed the analgesic effects of THC being "equivalent to codeine." A 1997 study made similar findings related to morphine.[55]

A 1999 article reviewing the body of scientific animal research concerning the analgesic effects of marijuana concludes that "[t]here is now unequivocal evidence that cannabinoids are antinociceptive [capable of blocking the appreciation or transmission of pain] in animal models of acute pain."[56]

In 2001, British researchers reported that cannabis extract sprayed under the tongue was effective in reducing pain in 18 of 23 patients who were suffering from intractable neuropathic pain.[57]

CANNABIS and CANCER

Cannabis has been found to help cancer patients with pain and nausea, and recent research indicates it has tumor-reducing and anti-carcinogenic properties as well. It has proven highly effective at controlling the nausea associated with chemotherapy, and its appetite-stimulation properties help combat wasting. Cannabis can also help control the pain associated with some cancers, as well as that resulting from radiation and chemotherapy treatment.

Cannabis and chemotherapy side effects

One of the most widely studied therapeutic applications for cannabis and the pharmaceutical drugs derived from cannabinoids is in the treatment of nausea and vomiting associated with cancer chemotherapy. Numerous clinical studies have reported that the use of cannabis reduces nausea and vomiting and stimulates appetite, thereby reducing the severity of cachexia, or wasting syndrome, in patients receiving chemotherapy treatment.

The 1999 Institutes of Medicine report concluded: "In patients already experiencing severe nausea or vomiting, pills are generally ineffective, because of the difficulty in swallowing or keeping a pill down, and slow onset of the drug effect. Thus an inhalation (but, preferably not smoking) cannabinoid drug delivery system would be advantageous for treating chemotherapy-induced nausea."[58]

A 1997 inquiry by the British Medical Association found cannabis more effective than Marinol, and a 1998 review by the House of Lords Science & Technology Select Committee concluded that "cannabinoids are undoubtedly effective as anti-emetic agents in vomiting induced by anti-cancer drugs. Some users of both find cannabis itself more effective."[59, 60]

In the last three years, there have been major advances in both cannabinoid pharmacology and in understanding of the cancer disease process. In particular, research has demonstrated the presence of numerous cannabinoid receptors in the nucleus of the solitary tract, a brain center important in control of vomiting.

Although other recently developed anti-emetics are as effective or more effective than oral THC, nabilone or smoked cannabis, for certain individuals unresponsive to conventional anti-emetic drugs, the use of smoked cannabis can provide relief more effectively than oral preparations which may be difficult to swallow or be vomited before taking effect, as the IOM report notes.

The psychoactive euphoriant effects of THC or inhaled cannabis may also provide an improvement in mood. By contrast, several conventional medications commonly prescribed for cancer patients, e.g. phenothiazines such as haloperidol (known as "major tranquillizers"), may produce unwanted side effects such as excessive sedation, flattening of mood, and/or distressing physical "extrapyramidal" symptoms such as uncontrolled or compulsive movements.

While clinical research on using cannabis medicinally has been severely limited by federal prohibition, the accumulated data speaks strongly in favor of considering it as an option for most cancer patients, and many oncologists do. Survey data from a Harvard Medical School study in 1990, before any states had approved medical use, shows that 44% of oncologists were then recommending cannabis to at least some of their patients. Nearly half said they would do so if the laws were changed. According the American Cancer Society's 2003 data, more than 1,300,000 Americans are diagnosed with cancer each year.[61] At least 300,000 of them will undergo chemotherapy, meaning as many as 132,000 patients annually may have cannabis recommended to them to help fight the side effects of conventional treatments.

As the Institutes of Medicine report concluded, "nausea, appetite loss, pain and anxiety … all can be mitigated by marijuana."

Research on cannabis and chemotherapy

Cannabis is used to combat pain caused by various cancers and nausea induced by chemotherapy agents. Over 30 human clinical trials have examined the effects of cannabis or synthetic cannabinoids on nausea, not including several U.S. state trials that took place between 1978 and 1986.[62] In reviewing this literature, Hall et al. concluded that ". . . THC [delta-9-tetrahydrocannabinol] is superior to placebo, and equivalent in effectiveness to other widely-used anti-emetic drugs, in its capacity to reduce the nausea and vomiting caused by some chemotherapy regimens in some cancer patients."[63] A 2003 study found "Cannabinoids—the active components of Cannabis sativa and their derivatives—exert palliative effects in cancer patients by preventing nausea, vomiting and pain and by stimulating appetite. In addition, these compounds have been shown to inhibit the growth of tumor cells in culture and animal models by modulating key cell-signaling pathways. Cannabinoids are usually well tolerated, and do not produce the generalized toxic effects of conventional chemotherapies."[64] Authors of the Institute of Medicine report, "Marijuana and Medicine: Assessing the Science Base," found that there are many cancer patients for whom cannabis should be a valid medical option.[65]

A random-sample anonymous survey conducted in the spring of 1990 measured the attitudes and experiences of oncologists concerning the antiemetic use of cannabis in cancer chemotherapy patients. Of the respondents expressing an opinion, a majority (54%) thought cannabis should be available by prescription.[66]

Cancer-fighting properties of cannabis

Recent scientific advances in the study of cannabinoid receptors and endocannabinoids have produced exciting new leads in the search for anti-cancer treatments. More than twenty major studies published between 2001 and 2006 have shown that the chemicals in cannabis known as cannabinoids have a significant effect fighting cancer cells. We now know cannabinoids arrest many kinds of cancer growths (brain, breast, leukemic, melanoma, phaeochromocytoma, etc.) through promotion of apoptosis (programmed cell death) that is lost in tumors, and by arresting angiogenesis (increased blood vessel production).

There is growing evidence of direct anti-tumor activity of cannabinoids, specifically CB1 and CB2 agonists, in a range of cancer types including brain (gliomas), skin, pituitary, prostate and bowel. The anti-tumor activity has led in laboratory animals and in-vitro human tissues to regression of tumors, reductions in vascularisation (blood supply) and metastases (secondary tumors), as well as the direct destruction of cancer cells (apoptosis). Indeed, research on the complex interactions of endogenous cannabinoids and receptors is leading to greater scientific understanding of the basic mechanisms by which cancers develop.

The findings of these studies are borne out by the anecdotal reports of such patients as Steve Kubby, whose cannabis use is credited with keeping rare, terminal cancers in a state of remission for decades beyond conventional expectations.

Research on Tumor Reduction

Although cannabis smoke has been shown to have precancerous-causing effects in animal tissue, epidemiological studies have failed to link cannabis smoking with cancer.[67-68] If smoke inhalation is a concern, cannabis can be used with a vaporizer, orally in baked goods, and topically as a tincture or a suppository.

Cannabinoids, the active components of cannabis, have been shown to exhibit anti-tumor properties. Multiple studies published between 2001 and 2003 found that cannabinoids inhibit tumor growth in laboratory animals.[69-73] In another study, injections of synthetic THC eradicated malignant brain tumors in one-third of treated rats, and prolonged life in another third by as much as six weeks.[74] Other journals have also reported on cannabinoids' antitumoral potential.[75-81] Italian research teams reported in 1998 and 2001 that the endocannabinoid anandamide, which binds to the same brain receptors as cannabis, "potently and selectively inhibits the proliferation of human breast cancer cells in vitro" by interfering with their DNA production cycle.[82-84] Cannabis has been shown in recent studies to inhibit the growth of thyroid, prostate and colorectal cancer cells.[85-87] THC has been found to cause the death of glioma cells.[88-89] And research on pituitary cancers shows cannabinoids are key to regulating human pituitary hormone secretion.[90-93]

In 2004 an Italian research team demonstrated that the administration of the non-psychoactive cannabinoid cannabidiol (CBD) to nude mice significantly inhibited the growth of subcutaneously implanted U87 human glioma cells. The authors of the study concluded that "… CBD was able to produce a significant antitumor activity both in vitro and in vivo, thus suggesting a possible application of CBD as an antineoplastic agent (an agent that inhibits the growth of malignant cells.)"[94]

More recently, investigators at the California Pacific Medical Center Research Institute reported that the administration of THC on human glioblastoma multiforme cell lines decreased the proliferation of malignant cells and induced apoptosis (programmed cell death) more rapidly than did the administration of an alternative synthetic cannabis receptor agonist.[95]

Cannabis and Movement Disorders

Movement disorders and neuro-degenerative diseases, which are sometimes interlinked, are among the conditions cannabis is particularly well suited to treat.

The therapeutic use of cannabis for treating muscle problems and movement disorders has been known to western medicine for nearly two centuries. In 1839, Dr. William B. O'Shaughnessy noted the plant's muscle relaxant and anti-convulsant properties, writing that doctors had "gained an anti-convulsive remedy of the greatest value."[96] In 1890 Dr. J. Russell Reynolds, physician to Queen Victoria, noted in an article in The Lancet that for "organic disease of a gross character in the nervous centers . . . India hemp (cannabis) is the most useful agent with which I am acquainted."[97]

Muscular spasticity is a common condition, affecting millions of people in the United States. It afflicts individuals who have suffered strokes, as well as those with multiple sclerosis, cerebral palsy, paraplegia, quadriplegia, and spinal cord injuries. Conventional medical therapy offers little help for spasticity problems. Phenobarbital and diazepam (Valium) are commonly prescribed, but they rarely provide complete relief, and many patients develop a tolerance, become addicted, or complain of heavy sedation. These drugs also cause weakness, drowsiness and other side effects that patients find intolerable.

Extensive modern studies in animals and various clinical states have shown that cannabis can treat movement disorders affecting older patients, such as tremors and spasticity, because cannabis has antispasticity, analgesic, antitremor, and antiataxia actions.[98-110]

In the federal court brief they filed in support of physicians' right to recommend cannabis, the American Public Health Association stated that "Marijuana is effective in treating muscle spasticity." They point out that the government's own Institutes of Medicine report on medical use of cannabis found that "current treatments for painful muscle spasms . . . have only limited effectiveness and their use is complicated by various adverse side effects." They go on to note that "a survey of British and American MS patients reports that after ingesting marijuana a significant majority experienced substantial improvements in controlling muscle spasticity and pain. An extensive neurological study found that herbal cannabis provided relief from both muscle spasms and ataxia (loss of coordination), a multiple benefit not achieved by any currently available medications" (amicus brief in Conant v. McCaffrey, 2001 filing).

Cannabis also has enormous potential for protecting the brain and central nervous system from the damage that creates various movement disorders. Researchers have found that cannabinoids fight the effects of strokes, as well as brain trauma, spinal cord injury, and multiple sclerosis. More than 100 research articles have been published on how canna-binoids act as neuroprotective agents to slow the progression of such neurodegenerative diseases as Huntington's, Alzheimer's and particularly Parkinson's, which affects more than 52% of people over the age of 85.

The contemporary understanding of the actions of cannabis was spurred by the discovery of an endogenous cannabinoid system in the human body. This system appears to be intricately involved in normal physiology, specifically in the control of movement.[111-115] Central cannabinoid receptors are densely located in the basal ganglia, the area of the brain that regulates body movement. Endogenous cannabinoids also appear to play a role in the manipulation of other transmitter systems within the basal ganglia—increasing transmission of certain chemicals, inhibiting the release of others, and affecting how still others are absorbed. Most movement disorders are caused by a dysfunction of the chemical loops in this part of the brain. Research suggests that an endo-genous cannabinoid tone participates in the control of movements.[116-120]

Endocannabinoids have paradoxical effects on the mammalian nervous system: Sometimes they block neuronal excitability and other times they augment it. As scientists are developing a better understanding of the physiological role of those natural cannabinoids, or endocannabinoids, it is becoming clear that these chemicals may be involved in the pathology of several neurological diseases. Researchers are identifying an array of potential therapeutic targets within the human nervous system. They have determined that various cannabinoids found in the cannabis plant interrupt the synthesis, uptake or metabolism of the endocannabinoids that drive the progression of Huntington's disease, Parkinson's disease, and tremor.[121-122]

Parkinson's disease has been linked to dysfunction in the body's dopamine system, specifically the production of too much of the neurotransmitter glutamate and oxidative damage to dopaminergic neurons. Studies have found a tight association between cannabinoids and dopamine, and recent research has produced anatomical, biochemical and pharmacological evidence supporting a role for the endogenous cannabinoid system in the modulation of dopaminergic transmission. Cannabinoid receptors switch between blocking and enhancing dopamine signaling. Cannabinoids neuroprotective action appears to result from their ability to inhibit reactive oxygen species, glutamate and tumour necrosis factor.

Cannabis and Alzheimer's Disease

Alzheimer's disease is another neuro-degenerative condition for which cannabis and cannabinoid therapies show promise, both for treating the symptoms and the underlying disease.

Alzheimer's disease is widely held to be associated with oxidative stress due, in part, to the membrane action of beta-amyloid peptide aggregates. A laboratory study published in 2004 indicates that one of the cannabis plant's primary components, cannabidiol (CBD), exerts a combination of neuroprotective, anti-oxidative and anti-apoptotic effects by inhibiting the release of the toxic beta-amyloid peptide.[123]

Another cannabinoid, THC, has also has been shown to reduce the agitation common to Alzheimer's sufferers, according to findings presented in 2003 at the American Society of Consultant Pharmacists' 34th annual meeting.[124] Agitation is the most common behavioral management problem in patients with Alzheimer's and affects an estimated 75 percent of people with the disease. It may lead to a variety of symptoms ranging from physical and/or verbal abusive postures, physically non-aggressive conduct including pacing and restlessness, as well as verbally disturbed behaviors such as screaming and repetitive requests for attention.

This study and the Institutes of Medicine report also show THC to be effective in combating the anorexia or wasting syndrome common to Alzheimer's sufferers, since food refusal is a common problem in patients who suffer from Alzheimer's-type dementia. The appetite-stimulation properties of cannabis are some of the most well established in clinical research.[125]

This new research on cannabis and Alzheimer's disease, coupled with the extensive work done on other neuroprotective qualities of cannabis and its components, indicates that cannabis may become the source of the most effective treatments for battling the Central Nervous System diseases that afflict millions of elderly Americans.

How Cannabis Compares to Other Treatments

Arthritis Medications

Nearly 100 medications are listed by the Arthritis Foundation website for use with arthritis or other related conditions, such as fibromyalgia, psoriasis, osteoporosis and gout. These medicines include aspirin, ibuprofen and other oral and topical analgesics that dull pain. The most commonly used analgesic, acetaminophen (aspirin-free Anacin, Excedrin, Panadol, Tylenol) is usually not associated with side effects, though long-term use of acetaminophen is thought to be one of the common causes of end-stage renal disease. To effectively control arthritis, aspirin must be taken in large, continuous doses (1000-5400 mg daily), which can cause stomach pain or damage; it is believed to cause more than 1,000 deaths annually in the United States. For that reason, some doctors prescribe one of several chemical variations referred to as nonacetylated salicylates, such as CMT, Tricosal, and Trilisate, which can cause deafness or ringing in the ears in large doses.

Much stronger analgesics are also prescribed for arthritis, sometimes along with acetominophen. These are: codeine (Dolacet, Hydrocet, Lorcet, Lortab, Vicodin);morphine (Avinza, Oramorph); oxycodone (Oxycontin, Roxicodone); propoxyphene(Percocet, Darvon, Darvocet) and tramadol (Ultram, Ultracet). These medicines can cause psychological and physical dependence, as well as constipation, dizziness, lightheadedness, mood changes, nausea, sedation, shortness of breath and vomiting. Taking high doses or mixing with alcohol can slow down breathing, a potentially fatal condition.

Analgesics don't treat the inflammation that can cause severe arthritis pain. For inflammation, steroids, nonsteroidal anti-inflammatory drugs (NSAIDs) and newer COX-2 inhibitors are prescribed. Corticosteroids (Cortisone), prednisone and related medications can cause bruising, cataracts, elevated blood sugar, hypertension, increased appetite, indigestion, insomnia, mood swings, muscle weakness, nervousness or restlessness, osteoporosis, susceptibility to infection and thin skin.

Twenty NSAIDs are available with a doctor's prescription, with three of those also available over the counter. They are diclofenac (Arthrotec, Cataflam, Voltaren);diflunisal (Dolobid); etodolac (Lodine); fenoprofen calcium (Nalfon); flurbiprofen(Ansaid); ibuprofen (Advil, Motrin IB, Nuprin); indomethacin (Indocin); ketoprofen(Orudis); meclofenamate sodium (Meclomen); mefenamic acid (Ponstel); meloxicam(Mobic); nabumetone (Relafen); naproxen (Naprosyn, Naprelan); naproxen sodium(Anaprox, Aleve); oxaprozin (Daypro); piroxicam (Feldene); sulindac (Clinoril); and tolmetin sodium (Tolectin).

Side effects of NSAIDs include abdominal or stomach cramps, edema (swelling of the feet), pain or discomfort, diarrhea, dizziness, drowsiness or lightheadedness, headache, heartburn or indigestion, nausea or vomiting, gastric ulcers, stomach irritation, bleeding, fluid retention, and decreased kidney function. This is because NSAIDs act on arthritis by inhibiting prostaglandins, which protect the stomach lining, promote clotting of the blood, regulate salt and fluid balance, and maintain blood flow to the kidneys. The gastrointestinal complications of NSAIDS are the most commonly reported serious adverse drug reaction, though NSAIDs cause more than 7,600 annual deaths and 70,000 hospitalizations.

The newer group of arthritis drugs is known as cyclo-oxygenase-2 inhibitors (COX-2), which include Celebrex, Bextra and Vioxx. These medications have the same side effects as NSAIDS, except they are less likely to cause bleeding stomach ulcers and susceptibility to bruising or bleeding.

Non-selective NSAIDS have been associated with an increased risk of congestive heart failure. Less is known or has been concluded about the cardiovascular effects of COX-2 inhibitors, though a retrospective analysis of the risk of hospital admission for heart failure done by the Institute for Clinical Evaluative Sciences in Toronto, Canada suggests some may have serious side effects. The study of 130,000 older patients found that those using Vioxx had an 80% increased risk of hospital admission for congestive heart failure. Those using non-selective NSAIDS had a 40% increased risk, and those using Celebrex had the same rate of heart failure as people who had never used NSAIDS.

Antipyretic and anti-inflammatory effects of NSAIDs can mask the signs and symptoms of infection. Their use can interfere with the pharmacologic control of hypertension and cardiac failure in patients who take beta-adrenergic antagonists, angiotensin-converting enzyme inhibitors, or diuretics. Long-term use may damage chondrocyte (cartilage) function.

Only about 60% of patients will respond to any single NSAID. Approx-imately 10% of rheumatoid arthritis patients will not respond to any NSAID.

Biologic response modifiers such as adalimumab (Humira); etanercept (Enbrel); infliximab (Remicade), and anakinra (Kineret)) are prescribed to either inhibit or the supplement the immune system components called cytokines. Rare reports of lupus (with symptoms such as rash, fever and pleurisy) have been linked to treatment with adalimumab, etanercept and infliximab. Lupus symptoms resolve when the medication is stopped. Multiple sclerosis has rarely developed in patients receiving biologic response modifiers. Seizures have been reported with etanercept.

Chronic Pain Medications

According to the Institute of Medicine, "All of the currently available analgesic (pain-relieving) drugs have limited efficacy for some types of pain. Some are limited by dose-related side effects and some by the development of tolerance or dependence."

The opioid analgesics commonly used to combat pain include codeine (Dolacet, Hydrocet, Lorcet, Lortab); morphine (Avinza, Oramorph); oxycodone (Vicodin, Oxycontin, Roxicodone, Percocet, Roxicet); propoxyphene (Darvon, Darvocet) andtramadol (Ultram, Ultracet). These medicines can cause psychological and physical dependence, as well as constipation, dizziness, lightheadedness, mood changes, nausea, sedation, shortness of breath and vomiting. Taking high doses or mixing with alcohol can slow down breathing, a potentially fatal condition.

In addition, patients in pain are often prescribed muscle relaxants such as Robaxin and Flexeril; anti-anxiety agents such as Valium, Sinequan, Vistaril, Ativan and Xanax; hypnotics such as Halcion, Restoril, Chloralhydrate, Dalmane and Doral and anti-emetics such as Zofran, Compazine, Phenergan, Tigan and Marinol.

Robaxin's side effects include abnormal taste, amnesia, blurred vision, confusion, dizziness, drop in blood pressure and fainting, drowsiness, fever, flushing, headache, hives, indigestion, insomnia, itching, light-headedness, nasal congestion, nausea, pinkeye, poor coordination, rash, seizures, slowed heartbeat, uncontrolled eye movement, vertigo, vomiting and yellow eyes and skin.

Flexeril can cause abnormal heartbeats, aggressive behavior, agitation, anxiety, bloated feeling, blurred vision, confusion, constipation, convulsions, decreased appetite, depressed mood, diarrhea, difficulty falling or staying asleep, difficulty speaking, disorientation, double vision, excitement, fainting, fatigue, fluid retention, gas, hallucinations, headache, heartburn, hepatitis, hives, increased heart rate, indigestion, inflammation of the stomach, itching, lack of coordination, liver diseases, loss of sense of taste, low blood pressure, muscle twitching, nausea, nervousness, palpitations, paranoia, rash, ringing in the ears, severe allergic reaction, stomach and intestinal pain, sweating, swelling of the tongue or face, thirst, tingling in hands or feet, tremors, unpleasant taste in the mouth, urinating more or less than usual, vague feeling of bodily discomfort, vertigo, vomiting, weakness, and yellow eyes and skin

The newer antiemetics, AnzametKytril and Zofran, are serotonin antagonists, blocking the neurotransmitter that sends a vomiting signal to the brain. Rare side effects of these drugs include fever, fatigue, bone pain, muscle aches, constipation, loss of appetite, inflammation of the pancreas, changes in electrical activity of heart, vivid dreams, sleep problems, confusion, anxiety and facial swelling.

Reglan, a substituted benzamide, increases emptying of the stomach, thus decreasing the chance of developing nausea and vomiting due to food remaining in the stomach. When given at high doses, it blocks the messages to the part of the brain responsible for nausea and vomiting. Side effects include sleepiness, restlessness, diarrhea and dry mouth. Rarer side effects are rash, hives and decreased blood pressure

Haldol and Inapsine are tranquilizers that block messages to the part of the brain responsible for nausea and vomiting. Possible side effects include decreased breathing rate, increased heart rate, decrease in blood pressure when changing position and, rarely, change in electrical activity of the heart.

Compazine and Torecan are phenothiazines, the first major anti-nausea drugs. Both have tranquilizing effects. Common side effects include dry mouth and constipation. Less common effects are blurred vision, restlessness, involuntary muscle movements, tremors, increased appetite, weight gain, increased heart rate and changes in electrical activity of heart. Rare side effects include jaundice, rash, hives and increased sensitivity to sunlight.

Benadryl, an antihistamine, is given along with Reglan, Haldol, Inapsine, Compazine and Torecan to counter side effects of restlessness, tongue protrusion and involuntary movements. Its side effects include sedation, drowsiness, dry mouth, dizziness, confusion, excitability and decreased blood pressure.

Benzodiazepine drugs Ativan and Xanax are prescribed to combat the anxiety associated with chronic pain. Ativan causes amnesia. Abruptly stopping the drug can cause anxiety, dizziness, nausea and vomiting, and tiredness. It can cause drowsiness, confusion, weakness and headache when first starting the drug. Nausea, vomiting, dry mouth, changes in heart rate and blood pressure and palpitations are possible side effects.

Cancer Medications

The American Cancer Society lists 269 medicines currently prescribed to treat cancer and its symptoms, and to treat the side effects of other cancer drugs. Some drugs are prescribed for pain caused by cancer, and cancer patients report pain relief with cannabis therapy. Many chemotherapy agents cause severe nausea and 13 drugs are currently prescribed to treat nausea, including Marinol, a synthetic form of delta-9-THC, one of the active ingredients in cannabis.

Antiemetic medications used for treating nausea, and medications such as antihitamines that are sometimes prescribed in combination with antiemetics, are all discussed above, under pain medications.

Decadron (dexamethasone), a corticosteroid, is given with other chemotherapy drugs as an adjunct medication. Common side effects include increased appetite, irritation of stomach, euphoria, difficulty sleeping, mood changes, flushing, increased blood sugar, decreased blood potassium level. Possible side effects upon discontinuing the drug include adrenal insufficiency, weakness, aches, fever, dizziness, lowering of blood pressure when changing position, difficulty breathing, and low blood sugar.

Benzodiazepine drugs Ativan and Xanax are also prescribed to combat the effects of chemotherapy. Ativan causes amnesia. Abruptly stopping the drug can cause anxiety, dizziness, nausea and vomiting, and tiredness. It can cause drowsiness, confusion, weakness, and headache when first starting the drug. Nausea, vomiting, dry mouth, changes in heart rate and blood pressure, and palpitations are possible side effects.

In addition, in April 2003 the FDA approved the drug Emend (aprepitant) to help control delayed-onset nausea. It is given along with two other anti-nausea drugs. A regimen of three pills costs $250. The most common side effects with Emend are fatigue, nausea, loss of appetite, constipation and diarrhea.

Spasticity And Movement Medications

Benzodiazepines, baclofen, dantrolene sodium, and tizanidine are the most widely used agents for reduction of spasticity. At high dosages, oral medications can cause unwanted side effects that include sedation, as well as changes in mood and cognition.

Benzodiazepines, which include Diazepam (Valium) and Clonazepam (Klonopin, Rivotril) are centrally acting agents that increase the affinity of GABA to its receptor. Diazepam is the oldest and most frequently used oral agent for managing spasticity. Benzodiazepine side effects include sedation, weakness, hypotension, GI symptoms, memory impairment, incoordination, confusion, depression and ataxia. Tolerance and dependency may occur and withdrawal on cessation. Tolerance may also lead to unacceptable dosage escalation.

Baclofen (Lioresal) has been widely used for spasticity since 1967. It is a GABA agonist. Tolerance to the medication may develop. Baclofen must be slowly weaned to prevent withdrawal effects such as seizures, hallucinations and increased spasticity. It must be used with care in patients with renal insufficiency as its clearance is primarily renal. Side effects are predominantly from central depressant properties including sedation, ataxia, weakness and fatigue. May cause depression when combined with tizanidine or benzodiazepines.

Dantrolene Sodium (Dantrium) acts peripherally at the level of the muscle fiber and works best for cerebral palsy and traumatic brain injury. Because the action of dantrolene sodium is not selective for spastic muscles, it may cause generalized weakness, including weakness of the respiratory muscles. The side effects include drowsiness, dizziness, weakness, fatigue and diarrhea. In addition, hepatotoxicity (liver damage) occurs in < 1% of patients who take dantrolene sodium.

Tizanidine (Zanaflex) facilitates short-term vibratory inhibition of the H-reflex. Tizanidine in conjunction with baclofen or benzodiazepines has potential additive effects, including sedation and the possibility of liver toxicity. Dry mouth, somnolence, asthenia and dizziness are the most common side effects. Liver function problems and hallucinations may also occur.

Cannabis vs. Other Medications

Cannabis: By comparison, the side effects associated with cannabis are typically mild and are classified as "low risk." Euphoric mood changes are among the most frequent side effects.  Cannabinoids can exacerbate schizophrenic psychosis in predisposed persons.  Cannabinoids impede cognitive and psychomotor performance, resulting in temporary impairment. Chronic use can lead to the development of tolerance. Tachycardia and hypotension are frequently documented as adverse events in the cardiovascular system. A few cases of myocardial ischemia have been reported in young and previously healthy patients. Inhaling the smoke of cannabis cigarettes induces side effects on the respiratory system.  Cannabinoids are contraindicated for patients with a history of cardiac ischemias.  In summary, a low risk profile is evident from the literature available. Serious complications are very rare and are not usually reported during the use of cannabinoids for medical indications.

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 Subject :Study confirms that cannabis is beneficial for multiple sclerosis.. Friday, 16 July 2010 
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Topic : Study confirms that cannabis is beneficial for multiple sclerosis

December 4th, 2009 in Medicine & Health / Neuroscience

 

Cannabis can reduce spasticity in multiple sclerosis (MS) patients. A systematic review, published in the open access journal BMC Neurology, found that five out six randomized controlled trials reported a reduction in spasticity and an improvement in mobility.

Shaheen Lakhan and Marie Rowland from the Global Neuroscience Initiative Foundation, Los Angeles, USA, searched for trials evaluating the cannabis extracts delta9-tetrahydrocannabinol (THC) and cannabidiol (CBD). According to Lakhan, "We found evidence that combined THC and CBD extracts may provide therapeutic benefit for MS spasticity symptoms".

Spasticity, involuntary muscle tension or contraction, is a common symptom of MS. Many existing therapies for this symptom are ineffective, difficult to obtain, or associated with intolerable side effects. In this study, reported incidence of side effects from cannabis, such as , varied greatly depending on the amount of cannabis needed to effectively limit spasticity, but the researchers note that side effects were also seen in the  groups. They add, "Considering the distress and limitations spasticity brings to individuals with MS, it is important to carefully weigh the potential for  with the potential for symptom relief ".

Lakhan concludes, "The therapeutic potential of cannabinoids in MS is comprehensive and should be given considerable attention".

More information: Whole plant  extracts in the treatment of spasticity in multiple sclerosis: a systematic review, Shaheen E Lakhan and Marie Rowland, BMC Neurology (in press), http://www.biomedcentral.com/bmcneurol/

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 Subject :Medical studies show cannabis effective for treating pain, spasms.. Friday, 16 July 2010 
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Topic : Medical studies show cannabis effective for treating pain, spasms

By Stephen C. Webster

With the results of a medical study summarized by a new report delivered to the California state legislature, the California Center for Medicinal Cannabis Research (CMCR) claims it has established scientific proof that inhaled cannabis holds medical value at or above the level of conventional prescription medicines used for a variety of ailments.

"As a result of the vision and foresight of the California State Legislature Medical Marijuana Research Act
(SB847), the CMCR has successfully conducted the first clinical trials of smoked cannabis in the United
States in more than 20 years," the group said in the study's conclusion summary. "As a result of this program of systematic research, we now have reasonable evidence that cannabis is a promising treatment in selected pain syndromes caused by injury or diseases of the nervous system, and possibly for painful muscle spasticity due to multiple sclerosis."

"Obviously more research will be necessary to elucidate the mechanisms of action and the full therapeutic potential of cannabinoid compounds. Meanwhile, the knowledge and new findings from the CMCR provide a strong science-based context in which policy makers and the public can discuss the place of these compounds in medical care."

"'There is good evidence now that cannabinoids (the active compounds in the marijuana plant) may be either an adjunct or a first-line treatment for … neuropathy,' said Dr. Igor Grant, Director of the CMCR, at a news conference at the state Capitol,'" according to Salem-News. "He added that the efficacy of smoked marijuana was 'very consistent,' and that its pain-relieving effects were 'comparable to the better existing treatments' presently available by prescription."

While the dangers of smoking remain, a study published by the Journal of Pharmeseutical Sciencesin 2006 showed that inhaling vapors from the cannabis plant, created by flushing heated air through a small chamber, is a "safe and effective" mode of transmission for the drug.

"The California Legislature established the [CMCR] in 2000 to examine whether the therapeutic claims of medical marijuana advocates could withstand scientific scrutiny," the Associated Press reported. "In 1996, state voters became the first in the nation to pass a law approving pot use for medical purposes."

The study found that cannabis can help ease the pain of neuropathy, migraine headaches and facial pain, AP noted. In tests on rats, a "cannabis-like drug" reportedly reduced nerve cells' pain signals.

READ THE CMCR'S FULL REPORT (pdf link).

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 Subject :Medical cannabis and movement disorders.. Friday, 16 July 2010 
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Topic : Medical cannabis and movement disorders

Excerpts on movement disorders from Marijuana and Medicine: Assessing the Science Base. Joy, Janet E.; Stanley J. Watson, Jr.; John A. Benson, Jr., Eds. Marijuana and Medicine: Assessing the Science Base. Washington, DC: Division of Neuroscience and Behavioral Health, Institute of Medicine. 1999. 259 p.:

Movement Disorders

Movement disorders are a group of neurological conditions caused by abnormalities in the basal ganglia and their subcortical connections through the thalamus with cortical motor areas. The abundance of CB1 receptors in basal ganglia and reports of animal studies showing the involvement of cannabinoids in the control of movement suggest that cannabinoids would be useful in treating movement disorders in humans. The movement disorders most often considered for marijuana or cannabinoid therapy are dystonia, Huntington's disease, Parkinson's disease, and Tourette's syndrome. Movement disorders are often transiently exacerbated by stress and activity and improved by factors that reduce stress. This is of particular interest because for many people marijuana reduces anxiety.

Dystonia

Dystonia can be a sign of other basal ganglion disorders, such as Huntington's disease and tardive dyskinesia (irreversible development of involuntary dyskinetic movements) and can be a primary basal ganglion disorder. Dystonia can cause mild to severe disability and sometimes pain secondary to muscle aching or arthritis. Some dystonias are genetic; others are caused by drugs. The specific neuropathological changes in these diseases have not been determined.

No controlled study of marijuana in dystonic patients has been published, and the only study of cannabinoids was a preliminary open trial of cannabidiol (CBD) that suggested modest dose-related improvements in the five dystonic patients studied.(30) In mutant dystonic hamsters, however, the cannabinoid receptor agonist, WIN 55,212-2, can produce antidystonic effects.(153)

30. Consroe P, Sandyk R, Snider SR. 1986. Open label evaluation of cannabidiol in dystonic movement disorders. International Journal of Neuroscience 30:277-282.

153. Richter A, Loscher W. 1994. (+)-WIN55,212-2 A novel cannabinoid receptor agonist, exerts antidystonic effects in mutant dystonic hamsters. European Journal of Pharmacology 264:371-377.

Huntington's Disease

Huntington's disease is an inherited degenerative disease that usually appears in middle age and results in atrophy or loss of neurons in the caudate nucleus, putamen, and cerebral cortex. It is characterized by arrhythmic, rapid muscular contractions (chorea), emotional disturbance, and dementia (impairment in intellectual and social ability). Animal studies suggest that cannabinoids have antichoreic activity, presumably because of stimulation of CB1 receptors in the basal ganglia.(129,168)

On the basis of positive results in one of four Huntington's disease patients, CBD and a placebo were tested in a double-blind crossover study of 15 Huntington's disease patients who were not taking any antipsychotic drugs. Their symptoms neither improved nor worsened with CBD treatment. (27,164)

The effects of other cannabinoids on patients with Huntington's disease are largely unknown. THC and other CB1 agonists are more likely candidates than CBD, which does not bind to the CB1 receptor. Those receptors are densely distributed on the very neurons that perish in Huntington's disease.(152) Thus far there is little evidence to encourage clinical studies of cannabinoids in Huntington's disease.

27. Consroe P, Laguna J, Allender J, Snider S, Stern L, Sandyk R, Kennedy K, Schram K. 1991. Controlled clinical trial of cannabidiol in Huntington's disease. Pharmacology, Biochemistry and Behavior (New York) 40:701-708.

129. Miller AS, Walker JM. 1995. Effects of a cannabinoid on spontaneous and evoked neuronal activity in the substantia nigra pars reticulata. European Journal of Pharmacology 279:179-185.

152. Richfield EK, Herkenham M. 1994. Selective vulnerability in Huntington's disease: Preferential loss of cannabinoid receptors in lateral globus pallidus. Annals of Neurology 36:577-584.

164. Sandyk R, Consroe P, Stern P, Biklen D. 1988. Preliminary trial of cannabidiol in Huntington's disease. Chesher G, Consroe P, Musty R., Editors, Marijuana: An International Research Report. Canberra: Australian Government Publishing Service.

168. Sanudo-Pena MC, Walker JM. 1997. Role of the subthalamic nucleus in cannabinoid actions in the substantia nigra of the rat. Journal of Neurophysiology 77:1635-1638.

Parkinson's Disease

Parkinson's disease, a degenerative disease, affects about 1 million Americans over the age of 50. It is characterized by bradykinesia (slowness in movement), akinesia (abrupt stoppage of movement), resting tremor, muscular rigidity, and postural instability.

Theoretically, cannabinoids could be useful for treating Parkinson's disease patients because cannabinoid agonists specifically inhibit the pathways between the subthalamic nucleus and substantia nigra and probably also the pathways between the subthalamic nucleus and globus pallidus (these structures shown in Figure 2.6).(165,169) The latter effect was not directly tested but is consistent with what is known about these neural pathways. Hyperactivity of the subthalamic neurons, observed in both Parkinson's patients and animal models of Parkinson's disease, is hypothesized to be a major factor in the debilitating bradykinesia associated with the disease.(36) Furthermore, although cannabinoids oppose the actions of dopamine in intact rats, they augment dopamine activation of movement in an animal model of Parkinson's disease. This suggests the potential for adjunctive therapy with cannabinoid agonists.(165-167,169)

At the time of this writing, we could find only one published clinical trial of marijuana involving five cases of idiopathic Parkinson's disease.(48) That trial was prompted by a patient's report that smoking marijuana reduced tremor, but the investigators found no improvement in tremor after the five patients smoked marijuana--whereas all subjects benefited from the administration of standard medications for Parkinson's disease (levodopa and apomorphine).(48) Although new animal data might someday indicate a use for cannabinoids in treating Parkinson's disease, current data do not recommend clinical trials of cannabinoids in patients with Parkinson's disease.

36. DeLong MR, Georgopoulos AP, Crutcher MD, Mitchell S J, Richardson RT, Alexander GE. 1984. Functional organization of the basal ganglia: Contributions of single-cell recording studies. CIBA Foundation Symposium 107:64-82.

48. Frankel JP, Hughes A, Lees AJ, Stern GM. 1990. Marijuana for Parkinsonian tremor. Journal of Neurology, Neurosurgery and Psychiatry 53:436.

165. Sanudo-Pena MC, Patrick SL, Patrick RL, Walker JM. 1996. Effects of intranigral cannabinoids on rotational behavior in rats: Interactions with the dopaminergic system. Neuroscience Letters 206:21-24.

166. Sanudo-Pena MC, Tsou K, and Walker JM. Cannabinoid dopamine interactions in the basal ganglia in an animal model of Parkinson disease. (in preparation).

167. Sanudo-Pena MC, Tsou K, and Walker JM. Superior colliculus and turning: Dopamine and cannabinoids. (in preparation).

169. Sanudo-Pena MC, Walker JM. 1998. Effects of intrastriatal cannabinoids on rotational behavior in rats: Interactions with the dopaminergic system. Synapse 30:221-226.

Tourette's Syndrome

Tourette's syndrome usually begins in childhood and is characterized by motor and vocal tics (involuntary rapid repetitive movements or vocalizations). It has been suggested that the symptoms might be mediated by a reduction in the activity of limbic-basal ganglia-thalamocortical circuits (shown in Figure 2.4). These circuits, while not well understood, appear to be responsible for translating a person's intentions to move into actual movements. Damage to these structures leads to either involuntary increases in movement (as in Huntington's disease) or the inability to make voluntary movements (as in Parkinson's disease). The nature of the deficit in Tourette's syndrome is unknown.

No clear link has been established between symptoms of Tourette's syndrome and cannabinoid sites or mechanism of action. Pimozide and haloperidol, two widely used treatments for Tourette's syndrome, inhibit effects mediated by the neurotransmitter dopamine, whereas cannabinoids can increase dopamine release.(154,181) The physiological relevance, if any, of these two observations has not been established.

Clinical reports consist of four case histories indicating that marijuana use can reduce tics in Tourette's patients.(75,163) In three of the four cases the investigators suggest that beneficial effects of marijuana might have been due to anxiety-reducing properties of marijuana rather than to a specific antitic effect.(163)

75. Hemming M, Yellowlees PM. 1993. Effective treatment of Tourette's syndrome with marijuana. Journal of Psychopharmacology 7:389-391.

154. Rodriguez de Fonseca F, Carrera MRA, Navarro M, Koob G, Weiss F. 1997. Activation of corticotropin-releasing factor in the limbic system during cannabinoid withdrawal [see comments Science 1997., 276:1967-1968]. Science 276:2050-2054.

163. Sandyk R, Awerbuch G. 1988. Marijuana and Tourette's syndrome. Journal of Clinical Psychopharmacology 8:444-445.

181. Tanda G, Pontieri FE, Di Chiara G. 1997. Cannabinoid and heroin activation of mesolimbic dopamine transmission by a common µ1 opioid receptor mechanism. Science 276:2048-2049.

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 Subject :Effectiveness Summary for Cannabis and GI Disorders.. Friday, 16 July 2010 
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Topic : Effectiveness Summary for Cannabis and GI Disorders

The effectiveness of cannabis for treating symptoms related to gastro-intestinal disorders is widely recognized. Its value as an anti-emetic and analgesic has been proven in numerous studies and has been recognized by several comprehensive, government-sponsored reviews, including those conducted by the Institute of Medicine (IOM), the U.K. House of Lords Science and Technology Committee, the Australian National Task Force on Cannabis, and others.

The IOM concluded, "For patients . . . who suffer simultaneously from severe pain, nausea, and appetite loss, cannabinoid drugs might offer broad-spectrum relief not found in any other single medication."12

The most common gastrointestinal disorders—Irritable Bowel Syndrome and Inflammatory Bowel Disease—affect millions of people. The disorders are different, but each causes a great deal of discomfort and distress and can be disabling. Painful cramping, chronic diarrhea or constipation, nausea, and inflammation of the intestines are all symptoms of the disorders and conditions for which cannabis may be effective.

Irritable Bowel Syndrome (IBS) is a common disorder of the intestines that leads to crampy pain, gassiness, bloating, constipation, diarrhea or both. Chronic, painful abdominal cramping is common. The cause of IBS is not known, and there is no cure. Researchers have found that the colon muscle of a person with IBS begins to spasm after only mild stimulation. IBS is at least partly a disorder of colon motility and sensation.

Inflammatory Bowel Disease (IBD) refers to both Ulcerative Colitis and Crohn's Disease. Ulcerative colitis causes inflammation of the lining of the large intestine. Crohn's disease causes inflammation of the lining and wall of the large and/or small intestine. The causes of IBD are not known, but there are indications that the disease has a genetic component. The immune system changes that accompany IBD suggest that it may be an immune disorder.

The most common symptoms of Crohn's Disease are pain in the abdomen, diarrhea, and weight loss. There may also be rectal bleeding and fever. The most common complications of Crohn's Disease are blockage of the intestine and ulceration that breaks through into surrounding tissues. Surgery is sometimes required.

The symptoms of Ulcerative Colitis include diarrhea, abdominal cramps, and rectal bleeding. Some people may be very tired and have weight loss, loss of appetite, abdominal pain, and loss of body fluids and nutrients. Joint pain, redness and swelling of the eyes, and liver problems can also occur. Hospitalization and surgery are sometimes needed.

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 Subject :The Benefits Of Medical Marijuana For Cancer Patients.. Friday, 16 July 2010 
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Topic : The Benefits Of Medical Marijuana For Cancer Patients

By: Bonnie Pranger

Due to being illegal or quasi-legal in many countries, you might not find as much information on the uses of medical marijuana (or marihuana) as you might expect. However, many studies have been conducted, and are still being conducted, about the medical uses of cannabis. Despite a somewhat blind governmental view in many countries, including Canada and the United States, these studies have shown repeatedly exactly how medical marijuana can help those suffering from severe illnesses such as cancer.

Traditional Cancer Treatments

Lung cancer, prostate cancer, breast cancer - in fact, most types of cancer all start the same basic way. Something causes cancer cells to divide and grow without pause, spreading badly damaged DNA. Those cells invade other tissues and, in most cases, form tumors. 

Cancer studies have taken leaps and bounds as far as finding treatments to slow, and sometimes stop, the spread of cancer. However, two of the most important treatments, chemotherapy and radiation therapy, also cause damage and, often, severe side effects. 

For instance, some of the most powerful, toxic chemicals are used in chemotherapeutic agents. Both treatments kill cancer cells, but healthy cells as well. Chemotherapeutic agents such as Adriamycin (doxorubicin) and Platinol (cisplatin) can, and have, caused immune suppression and multiple organ damage, but they also cause severe nausea and vomiting.

The vomiting can last over a period of days, to the point that some patients have actually torn their esophagus. Due to the vomiting and lack of appetite, severe dehydration and weigh loss is normal. In fact, many cancer patients begin having a reaction before chemotherapy begins, in "anticipation" of the side effects. Unfortunately, although chemotherapy and/or radiation therapy may be an integral part of their survival, many cancer patients decide not to take the therapies because the side effects are so severe.

Because of this, many are given a mix of anti-nausea drugs. Often, the anti-nausea drugs work. However, the drugs only give partial symptom control, while for others they give no control at all. In addition, those who take traditional medications may also suffer fever, bone pain, fatigue, anxiety, sleep problems and changes in heart activity, among other issues. This leaves cancer patients to suffer from the effects of the cancer itself, the side effects of the treatments, and the side effects of medications used to alleviate the initial side effects of the treatments.

Medical Marijuana for Cancer Patients

It has proven in many studies, performed by prestigious scientific and medical organizations and individuals, that medical marijuana can (and does) relieve pain and nausea. In fact, some of these studies go as far back as the 1970s and older.

For instance, in 1975, the New England Journal of Medicine published the results of a "double-blind" study on the effects of oral (ingested rather than smoked) tetrahydrocannabinol on nausea and vomiting. According to the study, "No patient vomited while experiencing a subjective "high". Oral tetrahydrocannabinol has antiemetic properties and is significantly better than a placebo in reducing vomiting caused by chemotherapeutic agents."

A 1999 report by the Institutes of Medicine concluded, "In patients already experiencing severe nausea or vomiting, pills are generally ineffective, because of the difficulty in swallowing or keeping a pill down, and slow onset of the drug effect. Thus an inhalation (but, preferably not smoking) cannabinoid drug delivery system would be advantageous for treating chemotherapy-induced nausea."

Although freedom from nausea and vomiting are two of the most noticed benefits of medical marijuana use, many have reported a reduction in the severity of wasting away. As well, they've notice a lessening in depression and other "side effects" brought on by the disease, including an increase in appetite. All of these things together have helped many cancer patients live a better, happier, more comfortable life. However, studies have also shown a shocking benefit.

Over twenty major studies in the past nine years have shown that cannabinoids (the chemicals in cannabis) actually fight cancer cells. In fact, it's been shown that cannabinoids arrest cancer growths of many different forms of cancer, including brain, melanoma and breast cancer. There's even growing evidence that cannabinoids cause direct anti-tumor activity.

Since the possibility was first realized, many more studies have been conducted, focused on the possibility of cannabinoids have anticarcinogenic effects. A 2007 study by the Institute of Toxicology and Pharmacology in Rostock, Germany focused on human cervical cancer (HeLa) cells. The cells were treated with specific cannabioids and THC. Even at low concentrations, MA and THC "led to a decrease in invasion of 61.5% and 68.1% respectively."

The benefits of medical marijuana for cancer patients are clear when it comes to increased appetite, reduction of pain, wasting, vomiting and nausea, as well as depression. Although its anticarcinogenic effects aren't quite as clear, ongoing research further points to the possibility that medical marijuana may actually be what many claim it is - a truly miraculous drug.

Health Canada grants access to marijuana for medical use to those who are suffering from grave and debilitating illnesses and those with chronic conditions. Medicinal-Marijuana.ca helps connect qualified patients with designated growers across Canada, providing information, support and resources to all Canadians who would like to access themedical cannabis program of Canada. Visit online today.

 

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 Subject :Statements supporting cannabis use for arthritis conditions.. Friday, 16 July 2010 
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Topic : Statements supporting cannabis use for arthritis conditions

Rheumatology reported in a Jan. 2006 article titled "Preliminary Assessment of The Efficacy, Tolerability and Safety of A Cannabis-based Medicine (Sativex) in The Treatment of Pain Caused By Rheumatoid Arthritis," by D.R. Blake et al.:

"In comparison with placebo, the CBM [cannabis-based medicine] produced statistically significant improvements in pain on movement, pain at rest, quality of sleep....

In the first ever controlled trial of a CBM in RA [rheumatoid arthritis], a significant analgesic effect was observed and disease activity was significantly suppressed following Sativex treatment."


Jan. 2006 - Rheumatology 

The Journal of Neuroimmunology, in their Sep. 2005 article titled "Cannabinoids and the Immune System: Potential For The Treatment of Inflammatory Diseases?" by J. Ludovic and Takashi Yamamura, stated:

"Studies from chronic cannabis smokers have provided much of the evidence for immunomodulatory [modifying or regulating the immune system] effects of cannabis in humans...

Cannabinoids can modulate both the function and secretion of cytokines [regulatory proteins] from immune cells.

Therefore, cannabinoids may be considered for treatment of inflammatory disease."


Sep. 2005 - Journal of Neuroimmunology 

Ethan Russo, MD, Senior Medical Advisor at the Cannabinoid Research Institute, stated in a 2005 Americans for Safe Access brochure titled "Arthritis and Medical Marijuana":
"Patients have long told us that cannabis has been helpful to them in the treatment of their arthritic conditions. 

Science has now demonstrated that the THC component of cannabis is a very effective analgesic (pain killer), and that the CBD (cannabidiol) component has unique immunomodulatory benefits as an antagonist of tumor necrosis factor-alpha, supporting benefits in treatment of rheumatoid arthritis."

2005 - Ethan Russo, MD 

Tod Mikuriya, MD, a psychiatrist and medical coordinator, stated in the 2002 article titled "Medicinal Uses of Cannabis," published on his website:

"Clinical interviews of over 6500 members at cannabis buyers clubs and patients in my office practice lead to this generalization: Many illnesses or conditions present with both inflammation and muscle spasm. Cannabis is both an antispasmodic and anti inflammatory....

Chronic inflammatory conditions like arthritis and lumbosacral disease responds well to cannabis compared with other analgesics.


2002 - Tod Mikuriya, MD 

J. Michael Walker, PhD, Professor of Psychology and the Linda and Jack Gill Chair of Neuroscience at the University of Indiana, in the Dec. 2000 issue of Arthritis Today, stated:
"The spinal cord is loaded with cannabinoid receptors. These cannabinoid compounds [from marijuana] apparently reduce swelling from inflammation [a major symptom of arthritis]. But more than that, they kill the pain from inflammation specifically. They work on the peripheral nerves that carry pain from your joint into the spinal cord."

Dec. 2000 - J. Michael Walker, PhD 

Americans for Safe Access stated in their 2005 brochure titled "Arthritis and Medical Marijuana":
"Cannabis has a demonstrated ability to improve mobility and reduce morning stiffness and inflammation. 

Research has also shown that patients are able to reduce their usage of potentially harmful Non-Steroidal Anti-Inflammatory drugs (NSAIDs) when using cannabis as an adjunct therapy."

2005 - Americans for Safe Access (ASA) 

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 Subject :HIV/Aids and Cannabis as a medicine.. Friday, 16 July 2010 
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Topic : HIV/Aids and Cannabis as a medicine

CANNABIS AND HIV/AIDS

The effectiveness of cannabis for treating symptoms related to HIV/AIDS is widely recognized. Its value as an anti-emetic and analgesic has been proven in numerous studies and has been recognized by several comprehensive, government-sponsored reviews, including those conducted by the Institute of Medicine (IOM), the U.K. House of Lords Science and Technology Committee, the Australian National Task Force on Cannabis, and others.

The IOM concluded, "For patients such as those with AIDS or who are undergoing chemotherapy and who suffer simultaneously from severe pain, nausea, and appetite loss, cannabinoid drugs might offer broad-spectrum relief not found in any other single medication."[12]

Research published in 2004 found that nearly one-quarter of AIDS patients were using cannabis. A majority reported relief of anxiety and/or depression and improved appetite, while nearly a third said it also increased pleasure and provided relief of pain.[13]

AIDS wasting syndrome was a very frequent complication of HIV infection prior to the advent of protease-inhibitor drugs,[14] and has been associated with major weight loss and cachexia, conditions that further debilitate its victims, who are already weakened by immune system failure and opportunistic infections. Cannabis has been a frequently employed alternative medicine for the condition, particularly in the USA,[15] because of its reported benefits on appetite and amelioration of other AIDS symptoms. In the rest of the world, where such medications are seldom affordable, AIDS wasting remains a common problem to the extent that it is known in Africa as 'slim disease'.[16]

Research findings on cannabis and HIV/AIDS

Beginning in the 1970s, a series of human clinical trials established cannabis' ability to stimulate food intake and weight gain in healthy volunteers. In a randomized trial in AIDS patients, THC significantly improved appetite and nausea in comparison with placebo. There were also trends towards improved mood and weight gain. Unwanted effects were generally mild or moderate in intensity. The possible benefit of cannabis in AIDS made it one of the lead indications for such treatment in the judgment of the American Institute of Medicine in their study.[17-23]

A preliminary safety trial conducted at the University of California at San Francisco found that inhaled cannabis does not interfere with the effectiveness of protease inhibitors in patients suffering from HIV or AIDS. It also found that patients in the study who used cannabis gained weight.[24]

Dronabinol (a.k.a. "Marinol" or oral THC) is approved by the U.S. Food and Drug Administration (FDA) as an anti-emetic and appetite stimulant for patients undergoing cancer chemotherapy or suffering from AIDS. The FDA approved the drug for this use in 1992 after several clinical trials determined it stimulated weight gain in HIV-infected patients.[25] In one study, 70 percent of patients administered Marinol gained weight.[26]

The 1999 report by the IOM concluded: "It is well recognized that Marinol's oral route of administration hampers its effectiveness because of slow absorption and patients' desire for more control over dosing. ... In contrast, inhaled marijuana is rapidly absorbed."[27]In a series of U.S. state studies in the 1980s, cancer patients given a choice between using inhaled marijuana and oral THC overwhelmingly chose cannabis.[28]

While the benefits of cannabis for HIV/AIDS patients are well established, research continues around the world. In 2002, researchers began a Canadian government-sponsored trial evaluating the appetite-enhancing effects of smoked cannabis in HIV/AIDS, the safety of short-term exposure to cannabis, its interaction with HIV medications, and its effects on nausea, pain, mood and neuro-cognitive function. In 2004 New South Wales in Australia will begin making cannabis available to HIV/AIDS patients and other seriously ill individuals for both research and compassionate use.

The University of California's Center for Medicinal Cannabis Research is currently conducting three HIV/AIDS related studies: two on cannabis as treatment for neuropathy, a condition which afflicts AIDS, diabetes and other patients with severe tingling and pain in their hands and feet, and one on how repeated treatment with cannabis affects the driving ability of patients with HIV-related neuropathy.

Over 30% of patients with HIV/AIDS suffer from excruciating pain in the nerve endings (polyneuropathies), many in response to the antiretroviral therapies that constitute the first line of treatment for HIV/AIDS.[29-31] But, there is no approved treatment for such pain that is satisfactory for a majority of patients. As a result, some patients must reduce or discontinue their HIV/AIDS therapy because they can neither tolerate nor eliminate the debilitating side effects of the antiretroviral first-line medications.[32]

Patients with various pain syndromes claim significant relief from cannabis. This is particularly true for patients suffering from neuropathic pain, a symptom commonly associated with HIV/AIDS and a variety of other illnesses or conditions.

In fact, British researchers have recently reported that cannabis extract sprayed under the tongue was effective in reducing pain in 18 of 23 patients who were suffering from intractable pain.[33] The validity of their experiences is corroborated by studies in which cannabinoids have been shown to be effective analgesics in animal pain models.[34]

Efficacy and side effects: How Cannabis Compares

The many medications currently employed to fight HIV/AIDS include many that produce serious side effects, including severe nerve pain, nausea and wasting. These side effects frequently threaten the health of the patient and require other medications to combat them.

Drugs commonly prescribed against AIDS-related weight loss includemegestrol acetate (Megace), an anticachectic. Serious side effects of this medicine include high blood pressure, diabetes, inflammation of the blood vessels, congestive heart failure, seizures, and pneumonia. Less serious side effects of this medicine include diarrhea, flatulence, nausea, vomiting, constipation, heartburn, dry mouth, increased salivation, and thrush; impotence, decreased libido, urinary frequency, urinary incontinence, urinary tract infection, vaginal bleeding and discharge (including breakthrough bleeding); disease of the heart muscle, palpitation, chest pain, chest pressure, and edema; shortness of breath, cough, pharyngitis, lung disorders, and rapid breathing; insomnia, headache, weakness, numbness, confusion, seizures, depression, and abnormal thinking.

Synthetic human growth hormones, such asSomatropin, also known as Genotropin, Humatrope, Norditropin, Nutropin, Nutropin AQ, Saizen, and Serostim, are also prescribed for AIDS wasting syndrome. Serious side effects of this medicine include: abdominal pain or swelling of the stomach; cancer; decrease in red blood cells; diarrhea; enlargement of face, hands, or feet; fever; headache; high blood pressure; high blood sugar; increased sweating; limp or pain in hip or knee; loss of appetite; pain in ear(s); pain and swelling where the shot was given; pain and tingling of fingers and toes; protein in the urine; rapid heart beat; severe tiredness; skin rash or itching; stomach upset; swelling of lymph nodes; trouble sleeping; vision changes; and vomiting. Less serious side effects of this medicine include: enlargement of breasts; increased growth of birthmarks; joint pain; muscle pain; swelling of hands, feet, or lower legs; unusual tiredness or weakness; and wrist pain.

Testosterone and anabolic steroids are being studied for use against AIDS wasting, as isThalidomide, a drug that was taken off the market in the 1960s when it was found to cause severe birth defects.

 

Opiod analgesics are commonly prescribed to combat the polyneuropathy associated with HIV/AIDS. The opioid analgesics commonly used to combat pain includecodeine(Dolacet, Hydrocet, Lorcet, Lortab, Vicodin);morphine (Avinza, Oramorph);Oxycodone (Oxycontin, Roxicodone, Percocet, Roxicet);propoxyphene (Darvon, Darvocet) and tramadol (Ultram, Ultracet). These medicines can cause psychological and physical dependence, as well as constipation, dizziness, lightheadedness, mood changes, nausea, sedation, shortness of breath and vomiting. Taking high doses or mixing with alcohol can slow down breathing, a potentially fatal condition.

Cannabis: By comparison, the side effects associated with cannabis are typically mild and are classified as "low risk." Euphoric mood changes are among the most frequent side effects.  Cannabinoids can exacerbate schizophrenic psychosis in predisposed persons.  Cannabinoids impede cognitive and psychomotor performance, resulting in temporary impairment. Chronic use can lead to the development of tolerance. Tachycardia and hypotension are frequently documented as adverse events in the cardiovascular system. A few cases of myocardial ischemia have been reported in young and previously healthy patients. Inhaling the smoke of cannabis cigarettes induces side effects on the respiratory system.  Cannabinoids are contraindicated for patients with a history of cardiac ischemias.  In summary, a low risk profile is evident from the literature available. Serious complications are very rare and are not usually reported during the use of cannabinoids for medical indications.

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 Subject :There is a lot going on in the community... Friday, 16 July 2010 
director
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Posts: 19
Location
Forum : Activism
Topic : There is a lot going on in the community.

Let us know if you have any great activist events, opportunities, or things we as members can be a part of to help make the world a better place.

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 Subject :Let us know if you have any great ideas for the collective.. Friday, 16 July 2010 
director
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Posts: 19
Location
Forum : Suggestions
Topic : Let us know if you have any great ideas for the collective

We are always looking for ways to make CCO better. Post your great ideas here!

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 Subject :Oakland considers limiting and licensing marijuana growers.. Thursday, 15 July 2010 
director
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Forum : In The News
Topic : Oakland considers limiting and licensing marijuana growers

Oakland considers limiting and licensing marijuana growers

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 Subject :What are your favorite types of cannabis meds?.. Thursday, 15 July 2010 
director
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Posts: 19
Location
Forum : Good Medicine
Topic : What are your favorite types of cannabis meds?

Strains? Flowers? Concentrates? Foods? Other?

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 Subject :CCO Now accepting membership applications. Services to begin August 20.. Thursday, 15 July 2010 
director
Joined: Wednesday, 14 July 2010
Posts: 19
Location
Forum : Whats Up
Topic : CCO Now accepting membership applications. Services to begin August 2010.

Subject :CCO Now accepting membership applications. Services to begin August 2010.

Hello there,

We appreciate your interest in California Coastal organics. We are currently pre-verifying patients for services set to begin in August 2010. To be a member of our collective just press the "Join Now" button and fill in you patient information so our staff may begin the verification process. A staffer will contact you afterwards to inform you of the status of your verification.

We provide the highest quality cannabis medicines to our patient members, including fresh raw cannabis varieties, high powered extractions, and food-based medicines. In addition, we provide natural foods and products to patients to assist in their wellness plans.

We look forward to serving you. Thanks for considering CCO to be your provider of cannabis therapeutics. We look forward to serving you for years to come.

Regards.

CCO Director

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