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Rodz opioid rants, continued

You thing YOU got problems?

The New York Times today has an article about synthetic opioid sales on the darknet , which are booming. It turns out that the Mexican Cartels are buying their synthetic opioids (mostly fentanyl derivatives ) in China, then trans-shipping them to the USA.  Kinda like Borders used to buy books from the publishers and trans-ship them to your local Borders bookstore.

Well, just like Amazon put Borders out of business by connecting customers directly to suppliers ,  enterpreneurs on the darknet are connecting labs in China with consumers in the USA, Canada, and Europe.  Turns out that you can buy a gram of synthetic fentanyl for around  US$122 on any of these online shopping sites.  Let’s say this stuff is furanyl fentanyl for the sake of argument, which is only 10 times more potent than heroin. So to substitute for a dime bag of 25% pure heroin, you would need 2.5 mg of furanyl fentanyl. There are 400 doses of this in the $122 gram that is going to be in your mailbox next week. So you get the equivalent of $10 of heroin (or $160 of diverted oxycontin) for about 30 cents.  Got a quarter and a nickel?

So the Mexican Cartels are in serious danger of going the way of Borders and Blockbuster Video.  However, this does nothing to reverse the opioid epidemic we have created in our country (remember, we tripled the number of opioid addicts thanks to pharmaceutical companies, doctors, and our elected representatives). The Drug War has now dropped the price of your standard two oxy-80’s a day blast from $160 all the way down  to 30 cents.  We had Moore’s Law in IT, maybe this is Sessions’ Law in drug policy.

The only way to stop this disaster is to decrease demand for opioids among consumers. We know  how to do this . Let’s do something that is inexpensive and effective, not ruinously expensive and harmful.

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Med Marijuana: over 80% good results in Crohn’s Disease and Ulcerative Colitis

Hot off the presses !

We looked at our results for inflammatory bowel disease (Crohn’s Disease and Ulcerative Colitis).  We have around 20 patients actively being treated with medical marijuana for their IBD.  Here are some results shaking down:

  • over 80% have at least good results (eating better, less distress)
  • almost 60% have excellent results (putting on weight, decreasing other medications, fistulas starting to heal)
  • the exact mix and dose of medical marijuana varies widely from patient to patient: you have to tailor it to each person’s specific body chemistry

TL;DR: Medical Marijuana works great for Inflammatory Bowel Disease.

cancer · chronic pain · Crohn's Disease · diabetes · marijuana doctor · marijuana use · medical marijuana · multiple sclerosis · nausea · NYS medical marijuana · spinal cord injury · video consultation

CB1 receptor agonist binding insights (geeky)

High Times reports  that  an international team of researchers  has actually figured out how the CB1 receptors in your brain respond to THC and other medicines that bind to them. It turns out that your CB1 receptors have way different structures depending on which medicine is actually binding to it. Here’s the article in Nature.

This information is important because when THC or any other medicine binds onto a CB1 receptor,  we can now start looking at how different shapes of this complex  cause different behaviors in your brain cells. This is an obvious guideline to choosing or designing medicines with specific effects on the CB1 receptor. This is very exciting stuff, and not just for geeks.

Go Science ! ! !

 

cancer · chronic pain · Crohn's Disease · diabetes · marijuana doctor · marijuana use · medical marijuana · multiple sclerosis · nausea · NYS medical marijuana · spinal cord injury · video consultation

Pure Ratios CBD vape

Many people have asked about the availability of CBD vapes online. Here is a video to help you inform yourself about this.

Obligatory Disclaimer:

We make no representation as to the reliability or quality of the products from the companies mentioned in this blogpost.  We cannot recommend any of these companies or products.  You have to do your own research and decide for yourself whether this is for you.

cancer · chronic pain · Crohn's Disease · diabetes · marijuana doctor · marijuana use · medical marijuana · multiple sclerosis · nausea · NYS medical marijuana · spinal cord injury · video consultation

CBD capsules and oil online information

Many people have asked about the availability of CBD capsules or oil online. Here is a video to help you inform yourself about this.

Obligatory Disclaimer:

We make no representation as to the reliability or quality of the products from the companies mentioned in this blogpost.  We cannot recommend any of these companies or products.  You have to do your own research and decide for yourself whether this is for you.

 

cancer · chronic pain · Crohn's Disease · diabetes · marijuana doctor · marijuana use · medical marijuana · multiple sclerosis · nausea · NYS medical marijuana · spinal cord injury · video consultation

How to take medical marijuana

Here are a couple of comments that have shaken down from listening to our patients as they fit medical marijuana into their overall treatment plan.

  • Medical marijuana may work best either as a standalone or together with other medicines. For example, in Parkinson’s the major benefit of medical marijuana may be to decrease the dystonia associated with the carbidopa, or to extend the time that these medicines are effective. Many pain patients can way decrease or cut out their opioids, but some can’t totally get off their other pain medicines including opioids.  Either way is OK.  You just have to see how it fits in with your other medicines.
  • If you are taking medical marijuana for pain or spasticity, you may need more on days when you are more active. I would much rather have my patients be more active and take a bit more medicine, than to sit around and take less medicine. The whole idea of pain medicine is to remove roadblocks from you getting active. Being active is the real treatment for your condition.

 

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Rodz opioid rant, continued

So the CDC just updated its reporting on our national opioid epidemic and it’s not looking good for our failed Drug War .  The good news: opioid prescribing nationally is DOWN to three times the 1999 levels.  The average American now gets only 1.75 mg of morphine every day, 640 mg/year.  The bad news: opioid prescribing continues to INCREASE in communities that are predominantly white, rural, low-education, and low-income. Northern NY was one region that saw an increase in opioid prescribing.

In short, national opioid prescribing is down, but our local opioid prescribing is UP.  Patients should be aware of this danger when they go to their health care providers with pain: if your doc dashes off a prescription for oxycodone or hydrocode, ask for “a non opioid treatment.”

If something sounds too good to be true, it probably is.

Opioids for chronic non cancer pain were Too Good to be True.  Don’t get sucked into this whirlpool.

 

 

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Medical Marijuana in Parkinsons Disease

A quick update on some of our experience in treating Parkinsons Disease with medical marijuana.  We have 10-20 patients in our program so far. Some observations:

  • these are medically fragile people, so dosing should start very low. The first question is will the Parkinson’s patient tolerate the medical marijuana?
  • side effects can happen with both THC and CBD in Parkinsons patients, so ask for side effects from both
  • in particular, watch for sedation in these patients
  • it may just be a side-effect limiting thing, but our excellent results are 20% and our at-least-good results are 30% in Parkinsons patients, lower than in other groups
  • In Other Words, the “theraputic window” of medical marijuana may be narrower in our Parkinsons population than in other populations
  • the benefit of medical marijuana in a Parkinson’s patient may just be to extend the duration of  action of their carbidopa, but this can be a big improvement in their daily life: you don’t get those 2 hours of tremors in the middle of the day in between carbidopa doses

So watch this space as we try to tune the medical marijuana to our Parkinsons patients’ body chemistry.

 

 

cancer · chronic pain · Crohn's Disease · diabetes · marijuana doctor · marijuana use · medical marijuana · multiple sclerosis · nausea · NYS medical marijuana · spinal cord injury

CBD bioavailability and you

Some of our patients have a great response to CBD alone or in combination with THC for their pain or other symptoms.  Some other patients either have no response or have side effects from CBD taken by mouth. So what gives?

We’ve been thinking a lot about CBD bioavailability.  Basically this concept asks how much CBD your body actually absorbs from whatever CBD you take by mouth or inhalation.  There is a great review paper on this topic and a lot of really useful info can be gleaned from it.

First, if you take CBD by mouth your body might only get 1% of the total amount you ate. So a 20 mg CBD capsule might deliver only 0.2 mg of CBD to your bloodstream.

Second, CBD bioavailability is very variable between people. Your friend may absorb 10% of the CBD they eat, but you might only absorb 0.1% of the same CBD that you eat. So maybe “I’m not responsive to CBD ” might really mean “My body just doesn’t absorb CBD from my gut.”

We know that the bioavailability of inhaled (eg vaped) CBD is around 30%. So if you vape 1 mg of CBD in a hit, your body sees 0.3 mg of that vaped CBD. This is way more than your body might see from  20 mg of CBD that you take by mouth.

So maybe if CBD taken by mouth either does not work for you or causes you side effects like indigestion, you might want to try vaping your CBD.

One source for such a vape that some people find helpful is the cbd store . Although we can not recommend it, we can inform you that there is a CBD vape cartridge/pen combination on this site. The 400 mg Pure Ratios CBD vape cartridge costs around $80 and the pen itself is $20. At around 250 hits per ml, this would deliver around 1.6 mg CBD per vape hit  At 30% bioavailability your body would see  around 0.48 mg of CBD per vape hit. So 3 vape hits per day might give you, on average, way more CBD than three  20 mg CBD capsules would. And the vape cartridge would last over 2 months.  Just information.

 

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vaporizer that has good reviews

xeo_void

A lot of our patients would like to find a vaporizer that is inexpensive and easy to use. The XEO VOID seems to fit this bill. It’s about $60 online, has great reviews from the vaping community, and seems to be really easy to use. You just stand it up, unscrew the top, and add your vaping oil. Easy.