I was pleased to see in Dr. Sanjay Gupta’s April 2018, Open Letter to Attorney General Jeff Sessions, in which he addressed how medicinal marijuana could help us work our way out of the opioid epidemic. It was Dr. Gupta’s plea to Attorney General Sessions that inspired me to share my own story. If I had known in 2009 and 2014 what I know now about cannabis, my recovery from brain surgery would have been much different. In 2005 the onset of migraines, vision problems, and pituitary dysfunction led to the discovery of a Rathke’s cleft cyst (RCC) in my brain. A Rathke’s cleft cyst is a benign growth that develops between the parts of the pituitary gland and the base of the brain. In 2009, after four years of increasing migraines and worsening symptoms, I decided to have the RCC removed by a neurosurgery team at the University of Colorado Hospital in Denver. The recovery was painful and took longer than I anticipated. My doctor prescribed me Oxycontin (oxycodone) for pain management. The Oxy successfully took the edge off the pain, but it also made me itchy, nauseous, constipated, irritable, and wholly unable to function normally. I had also heard stories of how addictive the medication could be as well as stories of accidental overdoses, and these concerned me. After about one week, I decided that the side effects were too much to manage, and I stopped taking it, only to be met with overwhelming pain. The Tylenol (acetaminophen) I was taking was not enough to manage the level of pain I was experiencing. I went back on the Oxycontin for another two weeks and battled through the side effects before finally deciding to quit Oxy once again and push through the remainder of my recovery with Tylenol only. By 2015 the hardest part of my recovery from this, and a second surgery, was behind me. I was able to move away from relying on prescription pain medications to manage my migraines. I returned full-time to my position as a health and special education teacher at an alternative high school in Colorado, where I worked with youth ranging in age from 14 to 18 years. In 2014 the sale of recreational marijuana began in the state of Colorado, and when I returned to work after surgery my students had a lot of questions about marijuana. They did not understand the differences between medicinal and recreational uses or products, and quite frankly neither did I. One student asked if a child who was using cannabis for treatment of epilepsy was also getting high, and I didn’t know the answer. I was frustrated by the lack of updated and accurate curricula to address all of these issues appropriately. My coworker and I set out to create science-based youth marijuana prevention curricula that addressed marijuana as a legal substance and differentiated between medicinal use and recreational use as well as recognized the important differences between adult use and use during adolescence when the brain is still developing. We spent a year learning from and working with specialists in various fields to develop our programs. What we learned reshaped our educational approach to prevention but also reshaped my personal approach to pain management. We were able to move away from the egg-and-frying-pan scare tactics into the world of science- and research-based educational practices. In 2016, still suffering from periodic migraines largely a result of my previous brain surgeries, I decided to put to use my knowledge about cannabis, the endocannabinoid system, and the compounds THC and CBD to see whether I could find a better form of migraine prevention and migraine pain management. Not a fan of smoking, I researched tinctures and edibles, working to find a THC and CBD balance that was effective for me. Ultimately, I found a form of cannabis-based pain management that works better and more consistently than any of the prescription painkillers I have taken since 2005. By and large I am able to treat my migraine pain with high CBD cannabis-based products without suffering any side effects. I have two teenage daughters, and I don’t hide from them the fact that I use medicinal marijuana to treat my migraines. Instead, I use it as an opportunity to talk with them about the important differences between my brain (as an adult) and their brains, which are still developing. We also talk about the medicinal uses of cannabis such as in treating childhood epilepsy and how that differs from recreational use. Had I known prior to my brain surgeries what I know now, I would not have had to choose between extreme pain and extreme Oxycontin side effects. I could have used cannabis as a form of pain management instead. This is an option that should be afforded to everyone. Sarah Grippa is a high school teacher in Colorado and the Co-Founder of the Marijuana Education Initiative.
Two weeks ago, Illinois Governor Bruce Rauner signed into law the Alternatives to Opioids Act. Effective immediately, doctors are authorized to prescribe marijuana to any patient who would qualify for an opioid prescription. The Illinois legislation allows doctors to test the extent to which marijuana can be used as an effective alternative to opioids for managing chronic pain. For a state that saw nearly 2,000 narcotics-related deaths in 2016, any opportunity to mitigate the risk of opioid addiction is a positive step. Many of our Illinois readers took action on behalf of this legislation. We are grateful for your support. “This is a great step in the right direction,” said Suzanne Carlberg-Racich, Director of Research for the Chicago Recovery Alliance. “I’m pleased to see an alternative for pain management that doesn’t have any potential for a fatal overdose.” Illinois is the first state to pursue such a policy through the legislative process, but it is not the first to take marijuana seriously as a tool with which to fight the opioid epidemic. In July, the New York State Department of Health filed emergency regulations that add “any condition for which an opioid could be prescribed” to their list of qualifying conditions for medical marijuana. In making the announcement, New York State Health Commissioner Dr. Howard Zucker said that “adding opioid replacement as a qualifying condition for medical marijuana offers providers another treatment option, which is a critical step in combating the deadly opioid epidemic affecting people across the state.” Pennsylvania, meanwhile, is taking a different approach. In May, the state’s Department of Health approved temporarily adding opioid addiction to its list of qualifying conditions for medical marijuana. Pennsylvania Secretary of Health Dr. Rachel Levine believes that the change will both “give physicians another tool for treatment of this devastating disease,” but also “allow for research to be conducted on medical marijuana’s effectiveness in treatment.” More rigorous research is needed before we can fully understand how effective marijuana can be as an opioid substitute or as a treatment for substance use disorder. Opponents to marijuana as an opioid substitute regularly cite a July study in The Lancet. The study indicated that patients with severe chronic pain who used both opioids and marijuana for pain relief over several years reported more pain than those who had used only opioids. It is somewhat disingenuous, however, to cite the Lancet study in this way. The study followed 1500 patients using opioids for severe chronic pain over four years, a subset of whom used both opioids and marijuana simultaneously. The Illinois legislation, and other comparable measures, provides for marijuana as a substitute for opioids, thus reducing the possibility of combining marijuana with a far more dangerous drug. The Lancet research does not address what the Illinois legislation will permit – the substitution rather than complementary use of marijuana. The Lancet research has two additional difficulties. It offers no way to assess why those who reported greater pain after four years were experiencing it or whether their pain would have increased no matter what they used. Moreover, because the patients were self-medicating in a jurisdiction where marijuana is illegal, there was no way to assess or control for the quality or quantity of the marijuana being used. Medical cannabis proponents understand that there is significant nuance in how marijuana should be used to treat chronic pain. Dr. Mark Wallace, an anesthesiologist who conducts research on marijuana, has said that low levels of THC can reduce pain but high amounts can actually increase it. When pain patients self-medicate, as they are more likely to do when they get marijuana through the black market rather than from a doctor, they are more likely to abuse the drug and less likely to experience pain relief. Of course, conducting research on the medicinal qualities of cannabis is a challenge considering its Schedule 1 status, as we’ve noted before. As researchers and doctors learn more they will be able to more effectively prescribe cannabis, either instead of or in addition to opioids. Multiple medical companies have already begun developing cannabis-based painkillers. There is still a long way to go in lessening our country’s dependence on opioids and lowering the rates of opioid overdoses. Since legalizing medical marijuana in 2015, Illinois has approved 42,000 patients for the program. In 2017 alone, 2.3 million patients in Illinois received a prescription for an opioid painkiller. Recent guidelines from the Centers for Disease Control and Prevention find no evidence that opioids are effective for treating chronic pain, and that as many as 1 in 4 patients who take opioids long-term struggle with addiction. Illinois, New York, and Pennsylvania are leading the way in using cannabis as an alternative to opioids, and as a way to fight substance use disorders. Hopefully other states will follow suit, and across the country we will see fewer opioid prescriptions, fewer opioid addicts, and fewer opioid-related deaths. Tom Houseman
Christy and Mark Zartler are the parents of an eighteen-year old child, Kara, who has multiple disabilities, including autism. Rev. Alexander Sharp had the privilege of meeting them while participating in the Texas Marijuana Policy Conference in Austin. They have been fighting a heroic battle for many years, at huge personal cost and risk, to help their daughter. They are advocates for legalizing medical marijuana. Please read their story here. Dear Friends of CNDP, My name is Christy Zartler. My husband Mark and I are parents of a severely autistic daughter. Eighteen years ago, I gave birth to premature identical twins. One of my twins, Kara, has multiple disabilities, including cerebral palsy and autism. Unfortunately, her primary mode of communication is self-abuse. She has had these behaviors since she was four. The worst of these behaviors is that she repeatedly hits herself in the head and face with close fists. She has been recorded in one school day to punch her face and ears 3,000 times. We had to do something for her. We’ve been to many physicians and she’s been on many different medications. Nothing worked. We’ve been trying to help her for 14 years. When Kara was 11 years old we found that cannabis in the form of an edible brownie stops these self-injurious episodes. After the discovery that cannabis was a very effective mood stabilizer for Kara, my husband tried a Cannabis vapor treatment. We blow up a cannabis vapor balloon and give it like a nebulizer treatment; it takes about 5 minutes to work. Like a light switch, her brain shifts, her mood changes abruptly, and she’s back to more acceptable behavior. She can do activities that she enjoys like walking, playing with her rice bin, and eating. After the treatment she expresses joy and happiness. We believe it’s good medicine for her and it helps relieve pain in her legs. It works a hundred percent of the time. It’s not the only medicine she takes, but it’s a vital part of her program. It’s a medical necessity. We use it for rescue purposes, when she’s having these dangerous meltdowns. In February 2017, my husband Mark released a treatment video to promote awareness for conditions like Kara’s. It shows that cannabis is an effective treatment. The video went viral. It’s been seen worldwide. We had no idea this would happen. Pictures and videos of her can be seen on her fb page “Kara Zartler”. Kara has always had a team of doctors. She is currently a patient at the Autism Center at The University of Texas Southwestern Medical Center. We haven’t given up on modern medicine. We can’t. She currently takes three pharmaceutical prescriptions. They help her, but nothing stops these severe episodes once they start. Once they get rolling, her mind gets into this loop. We’ve always told her doctors about the treatment. We take whatever legal risk we have to take because of drug interaction issues. Our doctors can’t offer us advice back, except to look for interaction precautions from what they know. It would be a blessing if we could actually have a two-way conversation with them about the use of cannabis for her conditions. Families like ours need legal access to whole plant cannabis and recourses so that we can feel safe and sleep better. Cannabis oil possession carries stiff punishments. If you live within 1000 square feet of a school a six-month supply of cannabis oils for one person is 10 years to life in prison. Everyone tells us that we should just move, but the reality is that we can’t. Kara has been thriving in the Richardson School District since she was three years old. It’s been a long process, and now we finally have an excellent program going at her school. The chances of us replicating that in a different district are zero. We also have our social services here. We’re on the Texas Medicaid Waver programs so we have in home help that helps us care for Kara so that we don’t have to institutionalize her. Many families in our autism community who live in legal states believe that cannabis works for their autistic children. These parents have shared videos of their children. After cannabis treatment the children are interacting with people, making eye contact, doing tasks and activities, smiling and enjoying their surroundings. I believe that the sick children here in Texas deserve to have access to this less harmful medication. What we really need is for Texas lawmakers to recognize that cannabis is medicine. Sincerely, Christy Zartler
On August 11, Rev. Alexander Sharp participated in the panel “Cannabis, Family, and Faith” at the Texas Marijuana Policy Conference. Here are excerpts from his presentation on medical marijuana, edited for brevity and clarity. I got involved in medical marijuana as a wedge issue, I’ll be the first to admit that. I live in Illinois. I wanted to change all the laws brought forward with the War on Drugs that are so oppressive. But you couldn’t even use the word “marijuana” with legislators in 2012 unless you were talking about medical uses. But after I had been involved for about a month medical marijuana as an end it itself became all-encompassing for me. I met people whose profound, sometimes unremitting, suffering was alleviated by only marijuana. If my career had ended when medical marijuana became legal in Illinois, I would have been content. Medical marijuana isn’t going to happen because of policy arguments, important as these are. What persuades people are the individual stories. In Illinois, it took three years to get the six or seven votes that put us over the top. Legislators who might not initially have been with us began to realize that they knew a family member, they knew a friend, whom medical marijuana had helped. I couldn’t be in Springfield the day the vote was taken, but I was sitting in my office watching the debate on TV. My eyes were filled with tears. My own state senator commented, “My father’s life as he was dying from cancer would’ve been dramatically different with medical marijuana.” Tears were streaming down his face, too. One of the arguments we got, of course, was, “You’re just the Trojan horse for legalization for recreational use.” If asked, I would have said, “I am for legalization. But when this is raised, there will be a passionate debate. Let’s respect democracy enough to realize the process does work without blocking a different use that has the capacity to relieve so much suffering.” You should be reaching out to engage clergy much more. I realize I’m in a state where there might be not as many “mainline” pastors as there are in Illinois. But please know that most mainline pastors understand the arguments for medical marijuana real fast. It’s about compassion, mercy, and healing. With evangelicals, it’s harder. They’re so worried about their own salvation and about an angry God and whether they’re going to live properly and get into the next world that they lose sight of the fact that’s not what Jesus was telling them. Jesus showed us that God loves us all, and calls us to love each other. Evangelicals, who read the Bible literally, should turn to Cor. 14: 1: “Make love your aim.” Medical marijuana is bringing the compassion and healing, indeed the love of God, to all in this world. There were very few things that made Jesus angry, but the Pharisees did. Why? Because of hypocrisy. They worshiped form over substance. The substance of cannabis is that it helps people. Let’s talk about the best of Christianity. The best of evangelical minds and hearts can be reached if we make that argument in the right way. I will close with the Christian concept of hope. Medical marijuana is going to pass in Texas. When it does, it will be because of the stories. All you have to do is persevere. Rev. Alexander Sharp
Politics should not dominate science. When researchers propose studies about the medicinal value of a drug or substance, research funding should be determined neither by the whims of politicians nor bureaucratic self-interest. Yet, when it comes to medical cannabis research, politicians and federal officials have an iron grip that have serious consequences on the lives of millions of Americans. The passage of the Controlled Substances Act in 1970 is one of the most important events in the history of the War on Drugs. Fueled by anti-drug rhetoric, the Controlled Substances Act established the Drug Scheduling System. This system, based more in already debunked drug myths, has determined the legality of various substances for medicinal and research purposes for decades. The most egregious category placement in the scheduling system is undoubtedly cannabis. Congress categorized cannabis as a Schedule 1 drug, deeming it to have a high potential for abuse and no accepted medical use. Incredibly, this placement meant that marijuana was considered as dangerous as heroin, and more dangerous than cocaine and meth. This scheduling placement has suffocated progress on cannabis research for decades. The regulatory hurdles that must be overcome are currently so complex and burdensome that they would be funny were the ramifications of such regulations not so serious. Reading through a recent report from The National Academies of Sciences, Engineering, and Medicine on the barriers to cannabis research are both dizzying and infuriating. Proposals for research involving cannabis must be submitted to the Drug Enforcement Adminstration, the National Institute of Drug Abuse, and any relevant state agencies. Some of these agencies brazenly display their biases in the types of research they approve. In 2015, more than eighty percent of cannabinoid research funded by the NIDA was on the harmful effects of marijuana, rather than any potential medicinal effects. Who could expect that the Drug Enforcement Administration would support research on cannabis as medicine? Yet its approval is required. The DEA in 2016 stated its intent to permit marijuana to be available from approved registries. But it has yet to approve a single application. The only acceptable source for marijuana used in research is the University of Mississippi. Many researchers have pointed out that the samples provided are not nearly as potent as the product sold legally in many states, hampering the effectiveness of research. That researchers in California cannot use marijuana legally grown and sold in California is absurd. As a result, research that could save and improve lives is difficult to perform. The first ever trial of the effect of medical marijuana on Post-Traumatic Stress Disorder in Military Veterans was only approved after seven years. Then, after another twenty months, the NIDA-approved cannabis was finally delivered, and was found to be contaminated with mold. Many medical researchers have been vocal about burdensome regulations. Sachin Patel, who studies cannabis at Vanderbilt University, has spoken publicly about the medical community’s desperate need for “well-controlled unbiased large scale research studies into the efficacy of cannabis for treating disease states.” Researchers also point out the absurdity of the claim that cannabis has a high potential for abuse and no accepted medical value. “In the biomedical research community,” Eckard College’s Gregory Geredemann has said, “it is universally understood that cannabis is a very safe, well-tolerated medicine.” Despite these regulations, and the anti-marijuana bias of the NIDA, research continues to prove that the medical value of cannabis is vast, and that access to it will reduce pain and save lives. Studies have shown that smoking cannabis can help reduce chronic pain in HIV-positive patients, symptoms of multiple sclerosis, and the development of Alzheimer’s. Earlier this year, two studies provided evidence that access to medical marijuana can help stem the rise of the opioid epidemic, potentially saving thousands of lives. More and more states are legalizing marijuana for both medical and recreational purposes, acknowledging that the potential for abuse is low and that there is undoubtedly medical value to the drug. Yet over the last decade attempts to downgrade cannabis from its Schedule 1 placement have been stymied by the federal government. In 2011, DEA Administrator Michele Leonhart rejected a petition to reclassify marijuana on the basis that the “risks of marijuana use have not been shown to be outweighed by specific benefits in well-controlled clinical trials.” The irony of this statement is, of course, that well-controlled clinical trials are almost impossible to run unless marijuana is reclassified. In 2016, the federal government was given another opportunity to reclassify the drug, and again chose to maintain the status quo. Statements in favor of reclassifying marijuana have come from The American Medical Association and the American College of Physicians. Earlier this year, a report from the Senate Appropriations Committee on barriers to marijuana research stated that “At a time when we need as much information as possible about these drugs, we should be lowering regulatory and other barriers to conducting this research.” Given the aggressive anti-drug stance of both President Trump and Attorney General Sessions, it is unlikely that such barriers will be lifted any time soon. For now, researchers must continue navigating highly burdensome regulations in order to study cannabis, including storing cannabis in a safe or a vault. It seems that knowledge about the medical benefits of cannabis is also being kept in a vault, one that lawmakers who cling to debunked claims about the dangers of marijuana refuse to open. Tom Houseman