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.

 

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

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.

 

 

marijuana doctor · marijuana use · medical marijuana · NYS medical marijuana · video consultation

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.

 

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

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.

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

Some facts shaking down after 700 patients

We have now certified about 700 patients in the NYS Medical Marijuana program. We have over 250 data points in our results database.  Some things that are shaking down, in no particular order seem to be:

  • sleep often gets better first, then pain gets better after you adjust the dosing
  • there is a lot of CB1 receptor heterogeneity in response to inhaled delta-9-THC versus ingested (eaten) 11-OH-delta-9-THC. This heterogeneity is not only in the response to the medicine, but also to the side effects from the medicine.
  • CBDs will give a very small percentage of people side effects like a buzz, GI issues like dyspepsia or diarrhea
  • you can get around 50% excellent symptom relief if you adjust medical marijuana in the first couple months
  • you can’t predict what or how much of what medical marijuana will work for any one person

More updates as we get more data.

 

marijuana doctor · marijuana use · medical marijuana · NYS medical marijuana

how to fix the opioid epidemic: part 3

 

Let’s talk about the opioid epidemic in the USA .

USA heroin use was dying out in the 1990s when a USA based pharmaceutical company developed oxycontin, a delayed release form of oxycodone.   Aggressive marketing by pharmaceutical companies in the USA led to the graph below.

That’s right, opioid prescriptions went up 2.85 x from 1991 to 2012. So US manufacturers used US doctors to get US pharmacies to increase opioid use by just under 3x.  Let’s say that again: all of these respectable businesses and professions worked together to TRIPLE consumer demand for opioids.  Doctors who did not “treat pain adequately” had multimillion dollar medical malpractice judgements and felony charges filed against them. There was an integrated marketing, lobbying, regulator-defanging, and “public education” campaign that caused this explosion of opioid use and addiction.  We tripled the number of people whose bodies were now physically addicted to opioids.

So what happened to  opioid overdose deaths? Here’s a graph from only the last half of the top graph: 2002 to 2015:

That’s right. Opioid OD deaths have TRIPLED since 2002, half the period covered in the first graph. Opioid OD’s now kill about as many Americans as car accidents. Let’s say that again: you now are as likely to die from an OD as you are to die from a car accident. We need to change our approach.

The USA is not the first country to experience an opioid epidemic. Portugal and Switzerland both had exploding use of heroin in the 1990s, just as bad as we have now.  These two countries reversed their own opioid epidemics at very low money and societal cost.

The way Portugal and Switzerland fixed their problem was by decreasing consumer DEMAND for opioids with prevention and rehabilitation programs. Policing was used but the emphasis of strategy and spending was on preventing and treating addiction.

Maybe we should be learning from them?

One reasonable part of this strategy might be to clamp down on the pharmaceutical companies and drug middlemen who are flooding our country (and now trying to flood other countries) with their opioids.  The cartels didn’t create this problem, our pharmaceutical companies created this problem. So why is El Chapo in jail while these guys are playing golf in Connecticut? Just askin’…

 

 

marijuana doctor · marijuana use · medical marijuana · NYS medical marijuana

how to fix the opioid epidemic: part 2

TL;DR: Cartels are making too much profit to police our way out of the opioid epidemic.

Let’s talk about the economics of illegal opioids. Why are the cartels diving into selling opioids in the USA like there is no tomorrow? You might be shocked to learn that there is a lot of money to be made. You probably will be shocked to learn how MUCH money there is to be made.

So let’s look at the street prices of various illegal opioids:

  • oxycontin
  • heroin
  • fentanyl (Mexican cartel acetyl fentanyl)
  • carfentanyl

Let us make some reasonable assumptions:

OK so let’s first talk about oxycontin.  The street price of oxycontin in the USA is right around $1 per milligram. So our addict is spending $160 /day for diverted oxycontin.  Governments have clamped down on providers so the supply of oxycontin, which used to be as abundant as buffalo on the Great Plains, has dried up. No more oxys from your doctor.

Opiods are physically addictive. When you get cut off, your body actually gets sick. Imagine having a really bad case of the flu. Now imagine drinking 8 Red Bulls every 8 hours while you are that sick. Now imagine that for weeks on end. That’s dope sick.  And you can make it all go away with just another hit. Are you getting the dynamic here?

So our addict asks around and finds enough heroin every day to replace their 160 mg/d oxycontin habit. Do the math and it works out that your average dime bag of heroin at 25% purity will substitute almost perfectly. So our addict’s habit is met at $10 per day, not $160 per day. So for 1/16 of the cost, heroin now substitutes for the hard to get and expensive oxycontin that our addict’s doctor is no longer providing.

How can anybody stay in business by selling heroin this cheaply? Let’s look at the economics of heroin, Mexican cartel fentanyl, and carfentanyl. The price of a kilo of each of these at the source is about US$3000. So our cartel has to move it across the border, distribute it, dilute it down to street strength, make the dime bags, and sell them. So how much money do they make at the final point of sale on the street corner from a kilo of each of our opioids?

Heroin purity at the street in the US averages around 25% (when I was a med student at Detroit General Hospital in the mid 1970s, the average purity of street heroin was 3%. So $10 dollars today buys you over 8 times as much heroin. How’s that drug war working guys?).  Doing the math, our $3000 kilo of heroin is worth $400,000 which gives us a profit of 133 times. This amount of profit allows everybody at every step of the supply chain to make from 2 to 10 times their investment. But wait, it gets better.

Our friends in the Mexican cartels are now synthesizing acetyl fentanyl, which is about 15 times more powerful than heroin.  They cook it up just like they cook up methamphetamine (btw, our War on Meth has led to the Mexican cartels taking over this market, dropping meth prices to 1/6 of what they were. That’s not a typo: we are getting way better meth at way cheaper prices as a result of our Drug War). And you don’t have to pay farmers, extract morphine gum etc, so there is way lower overhead on the production end for acetyl fentanyl.

So let’s do the math for a $3000 kilo of acetyl fentanyl at the source. You only need 1.67 mg of acetyl fentanyl to get the same effect as the 25 mg of heroin in our dime bag above. That’s why it’s so easy to OD on fent, it  is hard for dealers to measure it accurately enough not to kill their clients.  Our kilo of acetyl fentanyl made into equivalent dime bags and sold is now worth $5.98 million. That’s 1996 times its material cost. Now you understand why the cartels are starting to move fent more than heroin. You make over 10 times the profit per kilo of product moved. But wait, it gets even better.

Carfentanyl is an opioid that was developed for large animal veterinary work: it literally is used to put elephants to sleep. Both China and Mexico are supplying carfentanyl to the US market. Carfentanyl is about 3000 times more potent than heroin. Again, that’s not a typo: carfentanyl is three THOUSAND times as potent as heroin.

So let’s make up our standard dime bag, this time with carfentanyl as the opioid. It turns out that you need only 8 MICROgrams of carfentanyl to get the same blast that you get from 25 mg of heroin. Carfent has been found in lots of ODs because dealers’ scales don’t measure micrograms.  University science labs are now locking up their hi-sensitivity scales because dealers are paying big cash for them.

So let’s make up an equivalent bunch of dime bags of carfent and sell them, shall we? Our revenue from a $3000 kilo of carfentanyl sold as dime bags on the street is now $1.25 billion dollars. Yet again, this is not a typo: that’s 1.25 billion with a B . Our multiplier is now a healthy 62,500 times  material cost.  You can smuggle enough carfentanyl inside a lipstick tube to replace  100 kilos of heroin.

You can lock up as many addicts and cartel leaders as you want. You can interdict as many carloads or even truckloads of product that you want. You can jail as many bankers that launder money as you want (JK: the Wachovia and HSBC bankers that laundered billions of Sinaloa Cartel money had their bonuses delayed 6 months. Human Rights Watch, where are you?) There is so much money in this business that someone else will always be willing to step up.

So let’s stop this nonsense talk about our Drug War, shall we? The way we stop this is to decrease demand for these drugs at the consumer level. We know how to do this. It works, even in the USA. We need to demand a real solution to these problems before another generation is lost.