Medical News
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Cannabis Friendly Addiction Services Jennifer Janichek, MA Harborside Health Center Beginning in late spring a novel clinical services program began serving medical cannabis patients who are seeking substance misuse, addiction, and related mental health services. This distinctive program, located at two California based medical cannabis dispensaries, acknowledges the use of medical cannabis by the participants, whereas the majority of addiction and mental health services often relegate these individuals. Treatment providers commonly require abstinence from all drugs (including cannabis) and require urinalysis drug tests for evidence. At many “typical” treatment settings if an individual participating in the services uses a substance during this time period, they most often are expelled from the services. It is not a rare occasion for a clinician to turn away a patient at a session because of active substance use or intoxication. This example runs closely parallel to an unheard of scenario were a clinician would reject a session from a patient in treatment for major depression because he or she had a recent suicide attempt. Unfortunately, many program policies and practice standards are often contrary to what scientific study has revealed about the characteristics of addiction and treatment for substance misuse. When asked medical cannabis patients report various barriers in receiving clinical services such as cost, but the abstinence only paradigm, drug testing policies, and stigma felt at AA/NA groups are often the most named deterrent in receiving services. The mere status as a medical cannabis patient can stigmatize and stop an
individual seeking clinical supports. In addition, large-scale population surveys demonstrate a “treatment gap,” or in other words there are not enough available treatment spots for the number of people seeking the services. The neglect of available, evidence-based, and efficacious treatment services can be categorized as another devastating consequence of the war on drugs. The newly developed consumer-driven services diverge from the traditional addiction and mental health services standard and utilize various evidence-based approaches such a cognitive therapy. Following the harm reduction framework, this program not only embraces the therapeutic benefits of cannabis, but also attempts to minimize any limitations or side effects of the medication use. Patients utilize the therapeutic benefits of cannabis to help cope with the acute withdrawal symptoms from particular substances and also use cannabis as a replacement for more harmful substances as part of a treatment plan. In addition, may patients report mental health benefits from medical cannabis use such as relief from depressed thoughts and mood and relief from anxiety. The services include: individual assessment and brief counseling and group education, therapeutic, and peer support services. These are available for any patient at the health center free of charge. These services, called the Substance Use & Misuse Clinical Services Program, are just one of the offered services within the Holistic Care Clinic at Harborside Health Center. Harborside is a hybrid model medical cannabis health center and is located in San Jose and Oakland, CA. Jennifer Janichek, MA currently serves as a harm reduction clinical consultant for Harborside Health Center in Oakland and San Jose, CA. Ms. Janichek created the Substance Misuse & Use Clinical Services pilot program and most recently replicated the program in San Jose. Ms. Janichek is collecting data to measure the efficacy of the program.
Canadian Pain Study Cont. from Page 15
placebo. THC is one of the main active ingredients in the cannabis plant. Extremely Small Doses Used. Participants inhaled a single 25-milligram dose through a pipe three times daily for the first five days in each cycle, followed by a nine-day period without marijuana. They continued this for two months, rotating through all three potencies of THC plus the placebo.
Cannabis Connection "As a cannabis user, it can be really hard to get people to take you seriously," said Amy Brown, 28, a Toronto woman who wasn't a subject in the study, but uses marijuana to relieve chronic pain and swelling in her wrist, which was injured in a car crash five years ago. "To me, this study is vindication," Brown said. Brown said cannabis is more effective than chemical painkillers, which have unpleasant side effects. "I wasn't me anymore, I was a drone, I was robot-like," Brown said of conventional painkillers. "[When I started cannabis], I made a complete 180. I know what's going on now, I have a clear head."
The scientists measured pain intensity using a standard scale, with patients reporting the highest-strength cannabis was the most effective at reducing the pain and allowing them to sleep. Patients reported the pain reduction was "modest," less than one point on an 11-point scale for the strongest marijuana, reports Reuters. Patients reported no overall difference in their mood or "qualify of life." The most potent dose used reduced average daily pain scores by 0.7 points on an 11-point scale (5.4 versus 6.1 with placebo, 95 percent confidence interval for difference 0.02 to 1.4), according to Dr. Ware and colleagues, reports Crystal Phend at MedPage Today. Almost certainly, one reason the patients reported only "modest" pain relief with cannabis was that they were allowed only a single hit, three times a day, as part of the study. Patients rarely got high on the single hit they took through a pipe. The fact that relief was experienced, even with such tiny doses, speaks to the effectiveness of cannabis therapy in combating pain. None of the analgesic doses got plasma levels even halfway to the typical level seen among recreational users, according to the researchers. So one hopes that the next time marijuana's effect on pain is studied, they will at least use adequate dosages. "Noteworthy" Finding: Marijuana Improves Patients' Sleep But the finding that marijuana may actually help improve patients' sleep is "particularly noteworthy," according to Dr. Andrea Hohmann, who studies marijuana and pain at the University of Georgia and was not involved in the current study. "A lot of the treatments that are used for neuropathic pain... might also be associated with disruptions in sleep," Dr. Hohmann said. Researchers admitted the study doesn't address questions about the long-term effectiveness of cannabis therapy. Some patients also reported "adverse effects" such as dizziness, numbness or a burning sensation in areas of neuropathic pain. More research on marijuana's effectiveness in reducing pain will be based on this study, according to Dr. Ware.
The Canadian government has authorized almost 5,000 people to possess dried marijuana, and 3,500 hold personal use cultivation licenses, according to Health Canada. A doctor's authorization is required before a medical marijuana license is issued. Several court judgments forced Health Canada to get into the marijuana business a few years ago, so that patients wouldn't be forced to rely on the black market for their supplies. Despite its legalization for medical use and Health Canada's regulations, many in the medical community are still not open to the use of marijuana to relieve pain, according to Dr. Ware. "There's a lot of resistance from physicians, and in fact some of the policy-makers, that there isn't much evidence to support this," Dr. Ware said. I know some of the colleges and the CMA want to see evidence behind these claims before they will consider supporting or endorsing the regulations." "[This study] should provide some support to the fact that there is evidence now out there to support these claims," Dr. Ware said. The study adds to three previous investigations of smoked cannabis in coping with neuropathic pain, two of which involved patients with HIV, according to Henry McQuay, professor at Balliol College at the University of Oxford. Prof. McQuay noted, however, that the participant size of the study was small, the trial was short and it remains to be seen if marijuana can yield greater analgesia with fewer adverse effects than conventional drugs. "The current trial adds to the trickle of evidence that cannabis may help some of the patients who are struggling at present," Prof. McQuay wrote in an accompanying commentary to the study. "If medical cannabis is not available where a patient lives, then obtaining it will take the patient outside of the law, often for the first time in his or her life," Prof. McQuay wrote. "Good evidence would at least buttress that decision." Reprinted from Toke of the Town, http://www.tokeofthetown.com - Copyright (c) 2010 Village Voice Media.