Will Neuropathy Diagnosis Go Over The Fiscal Cliff

 Today's post comes from the Neuropathy Association E-news letter for November 2012 (see link below) and highlights a potentially very difficult time for neuropathy patients in the United States. Hopefully solutions can be found, now that plunging off the fiscal cliff has been temporarily averted but these sort of spending cuts are just the sort that will remain on the statute books irrespective of macro decision making in Washington. Not that EMGs are the be all and end all of neuropathy testing (a patient's account of symptoms is more often than not enough to confirm diagnosis) but EMGs and the like are useful tools in establishing the extent of neuropathic damage and certainly in measuring its progress. If you are living in the USA it may well be worth reading and supporting this  campaign by the Neuropathy Association.

 

A MESSAGE FROM THE PRESIDENT AND CEO
Tina Tockarshewsky November 2012

Dear Friend,

A clear and present danger for our community is now upon us, and your support is essential.

It was recently announced in the 2013 Medicare Physician Fee Schedule from the Centers for Medicare & Medicaid Services (CMS) that reimbursement payments to physicians for needle electromyography (EMG) tests and nerve conduction studies (NCSs) will be severely reduced by 30%-70% beginning on January 1, 2013. EMG and NCSs are the primary diagnostic tools for peripheral neuropathy as well as other neuromuscular diseases like ALS, MS, and Parkinson’s. Implementing these cuts will deny millions access to proper diagnosis and care.

We are hearing from many physicians that they will no longer be able to afford to practice neuromuscular medicine...and many currently in practice will simply stop seeing Medicare patients!

This Neurological Fiscal Cliff Will Hurt Neuropathy Patients!

 

This is a crisis unlike any we have ever known before…and is a potential game changer for ALL patients and medical professionals working with the neuropathy community. Early diagnoses will be reduced and misdiagnoses will increase. Patient access and care will suffer, exacerbating the challenges already facing neuropathy patients.

A 2010 poll by The Neuropathy Association showed that many patients already face significant delays in diagnosis, during which irreparable nerve damage continues:

 

Two Ways You Can Help

First: In the coming days, we will announce a process for contacting members of Congress and posting comments on these proposed changes on the Centers for Medicare & Medicaid Services website. Please watch your emails for this announcement and respond immediately. Please also know that we are working with our medical professional society partners to respond to this crisis.
And keep in mind that other insurers follow Medicare’s actions. So, even if you are not on Medicare, this change has the potential to impact everyone in the neuropathy community.

Second: Support our year-end fundraising efforts, and KEEP US IN THE FIGHT. In these difficult times for the economy and the Association, your generous contributions are our lifeline – and help protect your interests as well as those of untold numbers of future patients.
Thank you for taking action.

Neurologists to See Cuts in 2013 Medicare Payments
The Center for Medicare and Medicaid Services (CMS) recently released new code values that could result in decreased payments to neurologists. Specifically, physicians who provide nerve conduction and needle EMG services will face dramatic cuts of more than 50 percent for some services starting January 1, 2013. This is a drastic cut that will be especially hard on neurology practices large and small, many of which rely on these services to meet their bottom line. Patients also will pay the price with less access to these services. Private health insurers often follow Medicare payment rules as well, which will exacerbate the situation.
- American Academy of Neurology

Editor’s Note: Please refer to the President and CEO's message above for more information about this breaking issue that negatively impacts access to critical evaluation and care for people with neuropathy, and how The Neuropathy Association is working with the American Academy of Neurology, the American Association of Neuromuscular & Electrodiagnostic Medicine, and the American Academy of Physical Medicine & Rehabilitation to address this issue.

http://www.neuropathy.org/site/PageServer?pagename=Resources_PubArchivesM_E

Will Endomorphin Be The Replacement For Opioids For Neuropathy Patients

Today's post from sciencedaily.com (see link below) follows on from yesterday's post about endomorphin and its potential for chronic pain patients but whereas yesterday's post was from a national newspaper, this one is from the ever-reliable Sciencedaily.com and confirms what you may have read yesterday. If the predictions are correct, then commercially produced endomorphin may replace opioids as the pain killers of choice for those who've tried everything else and as a bonus, will deliver none of the side effects associated with opioids. This is fantastic news for long-term pain patients who not only have to manage their opioid prescriptions properly but have to face the wagging finger of media stigma, however unjust that may be. We still have to wait two years before the first human trials but the eventual benefits may make the wait easier.

New drug could be safer, non-addictive alternative to morphine
 January 28, 2016 Source: Tulane University
The peptide-based drugs, which mimic a natural brain chemical, target the same pain-relieving opioid receptor as morphine

Researchers at Tulane University and Southeast Louisiana Veterans Health Care System have developed a painkiller that is as strong as morphine but isn't likely to be addictive and with fewer side effects, according to a new study in the journal Neuropharmacology.

Using rats, scientists compared several engineered variants of the neurochemical endomorphin, which is found naturally in the body, to morphine to measure their effectiveness and side effects. The peptide-based drugs target the same pain-relieving opioid receptor as morphine.

Opium-based drugs are the leading treatments for severe and chronic pain, but they can be highly addictive. Their abuse results in thousands of overdose deaths in the United States annually. They can cause motor impairment and potentially fatal respiratory depression. Patients also build up tolerance over time, increasing the risk for abuse and overdose.

"These side effects were absent or reduced with the new drug," said lead investigator James Zadina, VA senior research career scientist and professor of medicine, pharmacology and neuroscience at Tulane University School of Medicine. "It's unprecedented for a peptide to deliver such powerful pain relief with so few side effects."

In the study, the new endomorphin drug produced longer pain relief without substantially slowing breathing in rats; a similarly potent dosage of morphine produced significant respiratory depression. Impairment of motor coordination, which can be of particular importance to older adults, was significant after morphine but not with the endomorphin drug.

The new drug produced far less tolerance than morphine and did not produce spinal glial cell activation, an inflammatory effect of morphine known to contribute to tolerance.

Scientists conducted several experiments to test whether the drug would be addictive. One showed that although rats would spend more time in a compartment where they had received morphine, the new drug did not affect this behavior. Another test showed that when the press of a bar produced an infusion of drug, the rats only increased efforts to obtain morphine and not the new drug. The tests are predictive of human drug abuse, Zadina said.

Researchers hope to begin human clinical trials of the new drug within the next two years.

Story Source:

The above post is reprinted from materials provided by Tulane University. Note: Materials may be edited for content and length.


Journal Reference:
James E. Zadina, Mark R. Nilges, Jenny Morgenweck, Xing Zhang, Laszlo Hackler, Melita B. Fasold. Endomorphin analog analgesics with reduced abuse liability, respiratory depression, motor impairment, tolerance, and glial activation relative to morphine. Neuropharmacology, 2016; 105: 215 DOI: 10.1016/j.neuropharm.2015.12.024

Tulane University. "New drug could be safer, non-addictive alternative to morphine: The peptide-based drugs, which mimic a natural brain chemical, target the same pain-relieving opioid receptor as morphine." ScienceDaily. ScienceDaily, 28 January 2016. .

http://www.sciencedaily.com/releases/2016/01/160128155006.htm

Will My Neuropathy Get Better

Today's post from neuropathyjournal.org (see link below) asks the simple question that every neuropathy patient asks shortly after hearing the diagnosis for the first time: will it get worse? The answer is that nobody can say with any 100% certainty how the disease will develop and LtCol Richardson makes the point that it's pointless expending too much energy on something that you can't change anyway. He suggests that it's better to find the cause and also a doctor who knows what he/she's doing and concentrate your energies on improving your symptoms and situation, rather than worrying about unknown factors regarding the disease getting worse or not. I'm not sure I agree with him about concentrating on finding the cause. In the end, you have nerve damage; there's no cure for that and you share symptoms with millions of others, irrespective of the cause. It's far better to follow his second suggestion and put all your energies into reducing the impact of the symptoms. Your medical history will point to the cause and various standard tests will indicate the extent of the nerve damage in your system but further than that, all you want as patient, is that the symptoms become bearable enough to live a normal life. Worth a read and worth following the Lt Col's links for more ideas on the subject.

Will My Neuropathy Get Worse?
By LtCol Eugene B Richardson, USA (Retired) BA, MDiv, EdM, MS

One issue neuropathy patient’s face is the fear that their neuropathy will grow progressively worse. Neurologists call this a progressive polyneuropathy. The truth: no one really knows if your neuropathy will worsen, stay the same or disappear. A neurologist shared that this may have more to do with the underlying cause of the neuropathy, genetics, and heaven only knows, issues.

I speak of this very fear in chapter twelve, Focus, in the DVD “Coping with Chronic Neuropathy”, and if you have not viewed this chapter, I suggest that you do so. The viewing will provide a better perspective.

Neuropathy patient fears are often increased by the coming and going (remitting and relapsing) of neuropathy symptoms. These patterns are a medically confirmed fact and also occur in many other chronic illnesses. Better recognized are the same patterns for some forms of MS (Multiple Sclerosis)!

Neurologists confirm that there are acute neuropathies that come on suddenly and then the symptoms disappear. In other neuropathies symptoms occur, disappear and then return at the same level. Other neuropathies occur, disappear and then return at increased levels and in more places of the body. Others come, go and then go away for years only to return with a vengeance!

The chronic neuropathies (affect one set of nerves) and polyneuropathies (affect many nerves), which increase for years are often referred to as progressive polyneuropathies. The mystery is increased as there seems to be no rhyme or reason for these patterns. The only thing I noticed is that when I increased activity, I have increased burning, pain or other symptoms and I neurologist tell me that this is due to making damaged nerves work.

For years between the emotional highs when my symptoms remitted (“Hurrah, they’re gone!”) and the emotional lows when they relapsed (“Oh no, they’re back!”), I was tempted to worry that my symptoms were going to worsen and guess what, they did! But one has to ask the question, did the energy spent on worry change anything? No! What I re-discovered was what I learned in Sunday school. It was better to spend my time and energy finding a doctor who was trained (neuromuscular neurologist) in the clinical approaches to neuropathy then to waste energy on worry. I needed a doctor, not worry, to focus on my symptoms. I needed a doctor working with me as a partner, while treating the symptoms and looking for the TYPE and/or CA– USE. Why finding the type of neuropathy important? Because as Dr. Latov in his book tells us, this can often point in the direction of a cause! I needed a medical Sherlock Holmes, not time worrying about what might happen.

This approach maintained a focus on self empowerment by learning all I could, while prodding the doctors with questions that helped them think and act. The most important question for you is not, will my neuropathy get worse, but what is the type of neuropathy and/or the underlying cause? Spend your energy looking for the type and/or cause, as no one knows if your neuropathy will worsen or not.

I know that for so many of you neuropathy has been a progressive illness which worsened over the years. Conversely, my progressive polyneuropathy has not killed me, for my neuropathy symptoms began at age 31 and I am now 76. Thirty-five years into the symptoms with a million denials with a diagnosis from mentally ill to idiopathic neuropathy. I was given one drug which drove me to talk backwards and then another that reduced pain by 80%. Five years later with the miracle of IVIg I am able to keep breathing and the chest muscle spasms stopped while reducing other mind numbing symptoms. This took many doctors, lots of research and knowledge, while asking good questions and giving doctors documents from experts. It may have been fear and anger which drove me forward, but it was these focused actions that brought help, not dwelling on my fears!

It is important to know which issue is important as you set goals for getting help. It is important to focus your energy on learning, getting help with symptoms and finding the cause and solutions for the diagnosed illness. I do not mean idiopathic neuropathy (of unknown cause). It is very difficult to find a solution, other than for symptoms, when the neuropathy is of unknown cause. Help the doctor think and pushing the system to do the testing that is now available. Click here to read about my opinion on Idiopathic Neuropathy.

Tests that are available will allow the doctor to know if the neuropathy is large or small fiber, motor, sensory or autonomic, axonal, immune-mediated, demyelinating or inflammatory and these clues can lead to a possible identification of the type and/or cause that is more helpful than idiopathic.

RESOURCE: Read Dr. Scott Berman’s book, as this book may provide insight on these issues. Click here to view the recommended Books On Neuropathy. Dr. Berman has untreatable CIDP (chronic inflammatory demyelinating polyneuropathy) and his book speaks to all neuropathy patients as one who has been in our shoes with many neuropathies. Dr. Berman empowers us to face creatively the emotional issues we ALL face in chronic illness.

https://www.neuropathyjournal.org/will-my-neuropathy-get-worse/

Will Generic Pregablin Lyrica Be Any Better For Neuropathy Patients

Today's post from psnc.org.uk (see link below) is a British view and advice to pharmacists on the changing status of Lyrica, as Pfizer's patent has now run out and generic versions will be coming onto the market. Pfizer in their wisdom, have decided to maintain a Lyrica patent for patients with neuropathy, at least until July 2017. This will effectively prevent other companies from bringing out a generic version until that date. Now in 2013, Pfizer were quite clear that pregabalin (Lyrica) was in their own eyes unsuitable for diabetes and HIV-related neuropathy patients. This was mainly due to adverse study outcomes and many court cases relating to side effect issues. The point is: what's changed? the answer: probably nothing: they still won't approve Lyrica for HIV and diabetes neuropathy patients and the FDA backs that up completely. So is this just a corporate move to prevent rivals from bringing generic Lyrica to the market too quickly? More importantly for neuropathy patients; will generic pregabalin (lyrica) be any more effective and any less dangerous for patients in the future. We'll have to wait and follow the recommendations for the US FDA and similar authorities across the world but until then, if your doctor is still prescribing Pregabalin (Lyrica) (generic or not) for your neuropathic problems, you need to have a serious discussion as to whether this is in fact, the best option.

Pregabalin (Lyrica) – Licensing differences between Lyrica and Generic
January 29, 2015

Pregabalin (Lyrica) patent is changing and generic pregabalin is becoming available. The NPA have issued advice (shown below) regarding the licencing of the products.

The NPA have also informed us that are also in the process of discussing this issue with the MHRA and Pfizer.

Dear Pharmacist
You may find in the coming months that generic pregabalin is available to order. I would like to highlight to you that although the patent for pregabalin expired in July 2014, this patent expiry related to the use of pregabalin in epilepsy and generalised anxiety disorder; Pfizer will retain a patent for the use of pregabalin in the treatment of peripheral and central neuropathic pain in adults until July 2017.
This means that until July 2017, generic manufacturers of pregabalin will only be able to obtain a licence for pregabalin for use in epilepsy and/or generalised anxiety disorder and Lyrica, Pfizer’s branded product, will remain the only product licensed for use in pain as well as epilepsy and generalised anxiety disorder.

Pfizer has indicated that it will contest any challenges to the patent for pain.

To avoid any possible patent infringement by pharmacists, steps will need to be taken to ensure that where generic pregablin is requested on a prescription the correctly licensed product is supplied. This may mean contacting the prescriber and establishing the indication and requesting that the prescription is amended and ordered by brand as Lyrica if necessary.

Although generic pregabalin is unlikely to differ clinically from the branded Lyrica, supplying the generic version of pregabalin for neuropathic pain may have the following implications for pharmacists:
Generic pregabalin preparations will not include information relating to neuropathic pain in the patient information leaflet and pharmacists will be supplying a product off-licence
Supplying generic pregabalin for neuropathic pain would not be in line with Medicines and Healthcare products Regulatory Agency’s risk hierarchy guidance for the supply of unlicensed medicinal products, which states that a UK-licensed product should always be supplied for the correct licensed indication
Using generic pregabalin for neuropathic pain may be deemed by Pfizer to be a patent infringement by all parties concerned, including the prescriber and the supplying pharmacist

Currently, reimbursement for NHS prescriptions for pregabalin is based on Lyrica. This may change when generic versions become available meaning that pharmacists may not be correctly reimbursed where Lyrica is supplied against a generically written prescription for pregabalin. I advise that where generic prescriptions for pregabalin are received, the prescriber is contacted to ascertain the indication. Where the indication is for neuropathic pain, the prescription should be returned to the prescriber for amendment to Lyrica. Prescriptions for pregabilin for epilepsy or generalised anxiety disorder can be dispensed with either Lyrica or appropriately licensed generic versions.

When supplying pregabalin for the treatment of epilepsy, pharmacists should also consider MHRA guidance issued in 2013 regarding the generic prescribing of antiepileptics. The guidance states that pregabalin does not generally need to be prescribed by brand for the treatment of epilepsy unless there are specific concerns such as patient anxiety and a risk of confusion or dosing errors.

For further information on this or any other query please contact the NPA Pharmacy Services Team on 01727 891 800 / 08447 364 201
or email pharmacyservices@npa.co.uk .

http://psnc.org.uk/sunderland-lpc/our-news/pregabalin-lyrica-licensing-differences-bewteen-lyrica-and-generic/

Will The Pothead Image Ruin The Chances Of Medical Cannabis

Today's post from cbc.ca (see link below) highlights one of the new problems associated with medical cannabis for nerve pain (amongst other conditions) and that is the stigma associated with die-hard cannabis smokers. Conservative thinkers see them as lazy and ineffectual; practically a danger to society! However, as this article suggests: as more and more areas legalise the drug for medical purposes, it may be up to the medical cannabis producers and retail outlets to change the image (however inaccurate) in order to promote the undoubted qualities cannabis can have. There will always be opposition of course; from those who have never tried it and those who fortunately for them, don't need it. It may be a long road ahead but the progress so far is nothing less than astonishing!

Stigma of the lazy pot-smoker hurts medical marijuana users 
By Peter Thurley, for CBC News Posted: Nov 24, 2016 
 
For many users, the high they get is an unwanted side-effect

Medical marijuana is used for, among other things, relieving pain, stimulating appetite, relieving nausea and relaxing patients suffering from PTSD or psychological other trauma. (Robert F. Bukaty/Associated Press)

About The Author

Peter Thurley is a Kitchener, Ont. based writing and communications consultant, helping non-profits, small businesses and political action groups effectively engage with stakeholders. A relatively new medical cannabis user, he has written further reflections on the politics of cannabis at peterthurley.ca.

When people hear that someone uses cannabis, they often give a nudge nudge​ wink wink and say, "Lucky you, getting high on weed, eh?"

I usually chuckle and reply that the official scientific name of the plant is "cannabis," and that it is medicine. For me, it's used to dull chronic nerve pain left after an invasive surgery to repair burst bowels and remove a 25-pound desmoid tumour.

It can also be used as an appetite stimulant, it quickly kills nausea and it relaxes anyone who needs to deal with frightening flashbacks of their time in hospital.



Different strains of marijuana are on the menu at a dispensary in Ottawa. (Stu Mills/CBC)

Yet the image of the lazy pot-smoker remains one of the most prevailing stigmas about medical cannabis users, and it was on full display recently during a CBC News interview with former NDP MP Peter Stoffer about cannabis use among veterans.

Veterans allowed too much pot, says former NDP MP Peter Stoffer

​Once the NDP's critic for veterans affairs, Stoffer, who is now the public spokesperson for Nova Scotia-based Trauma Healing Centers, quipped that the 10 grams a day of cannabis allowed under Veterans Affairs Canada rules is "an awful lot of marijuana to give one person." Veterans Affairs Minister Kent Hehr seems to agree, and announced this week that the limit will be scaled back to three grams.

In his interview, Stoffer added that veterans should be subject to a full lifestyle examination before being granted access to cannabis, suggesting that some might be using it simply to get high.

Novelty wears off

The novelty of being a cannabis consumer wears off quickly. For many medical cannabis users, the potential high is an unwanted side-effect.

So it was disappointing to read Stoffer repeat long-debunked myths about medical cannabis users looking for a buzz rather than relief in his thinly veiled comments about "lifestyle monitoring." That's simply not true.

And while the federal government does play a role in how veteran health care dollars are spent, it does not have the right to come between a patient and their doctor — nor should Veterans Affairs Canada be asking questions about a patient's lifestyle, financial status or eating habits, as suggested by Stoffer. They don't do it now, nor should they start. If they don't do it for other prescription medications, why should they do it for cannabis?

Lessons learned about legalized marijuana from Colorado's chief medical officer

As Canada moves towards full legalization, it will be incumbent on the burgeoning cannabis industry to take steps to explain the various ways of consuming cannabis. Extractions, for instance, take much more plant matter to produce than other methods such as smoking or vaporizing.

Indeed, according to Maxim Zavet, CEO at Emblem Cannabis, it may be that veterans are relying increasingly on oils instead of smoking the dried flower — something that requires more plant material and may not contain psychoactive ingredients like THC. Stoffer acknowledged that fact in a follow-up call I had with him, but he held fast to his position, saying, "Everyone knows that 10 grams is a lot."



Cannabis can be consumed in several different ways, like adding cannabis oil to a smoothie, as chef Cody Lindsay does here. (CBC)

Like me, Michael Blais, of Canadian Veterans Advocacy, respects Stoffer and applauds the work he did in the House of Commons. But he also agreed that these long-standing stigmas about medical cannabis must fall, especially for Canada's veterans, who have already given so much for the sake of our nation. "There aren't many of us who have sustained a battle injury," he reminded me.

Cooking with cannabis and what could be on Canada's menu

In 2017, Canada will become the first G7 nation to fully legalize cannabis use, both medically and recreationally. It would be a shame if Stoffer's cannabis myths — relics left over from the failed war on drugs — were to further disadvantage our veterans, right when they need our help the most.


This column is an opinion - for more information about our commentary section please read this editor's blog and our FAQ.

http://www.cbc.ca/news/opinion/medical-marijuana-stigma-1.3861027

Will legalising Marijuana help Neuropathy patients

The argument drones on but a successful outcome for chronic pain sufferers does seem to be getting nearer, especially after the results of yet more tests on the efficacy of cannabinoids as a neuropathic painkiller. Today's post comes from Genetic Engineering & Biotechnology News (see link below). There are other posts about how useful marijuana is for our health group (see list on the right) but this one is very clearly written and explains the situation in America at the moment. Of course, medical marijuana is already legal in various countries and states, or regions within countries but it's almost never a matter of course that it will be prescribed for you. It's been proved to be one of the very few effective neurological pain controls and is of great value to many neuropathy sufferers - the chance to be able to take advantage of its benefits, seems a no-brainer!

Medical Marijuana Policy Catches Up with Science
Bruce Mirken

Shifting Stance on Herbal Medicine by Government and Physicians Benefits Patients

Marijuana’s recorded use as a medicine goes back nearly 5,000 years. The ban on such use is a much newer phenomenon—72 years in the U.S., a bit more or less in other nations and in specific U.S. states—and one whose unhappy tenure is now apparently near an end. Simply put, research has made that ban increasingly untenable.

The two clearest signals of the sea change that is occurring came this past fall. In October, the Obama administration signaled a careful but hugely significant softening of the federal government’s dogmatic hostility toward medical marijuana. Instead of treating state medical marijuana laws either as nullities or as affronts to be attacked any way possible, a memo from the Department of Justice signaled a hands-off policy toward medical marijuana activities when such activities are clearly permitted by state law.

Less than a month later, the American Medical Association (AMA)—the largest and most institutionally conservative U.S. physicians’ group—announced a major reversal of its policy on the issue. The AMA’s old language had urged that marijuana “be retained in Schedule I” of the federal Controlled Substances Act. That classification deemed marijuana as having a high potential for abuse, lacking accepted medical uses in the U.S., and as unsafe for use even under medical supervision.

In contrast, Schedule II—still considered to have high abuse potential but declared to have accepted medical uses and to be safe for use under physician supervision—includes cocaine, morphine, and even methamphetamine. Stranger still is the fact that in pill form, THC—the component responsible for marijuana’s “high,” though not all of its therapeutic effects—is in Schedule III, with controls so mild that phoned-in prescriptions are allowed.

Some of us thought this classification of marijuana was ludicrous from the get-go, but a recent succession of controlled clinical trials has made the case irrefutable. And the AMA has noticed, replacing its old position with this: “Our AMA urges that marijuana’s status as a federal Schedule I controlled substance be reviewed with the goal of facilitating the conduct of clinical research and development of cannabinoid-based medicines and alternate delivery methods.” While carefully avoiding an endorsement of existing state medical marijuana laws, the new AMA stand represents a major shift.

The report accompanying the new policy makes clear that this shift was driven by research into medical marijuana, some of the most interesting of which has looked at marijuana for neuropathic pain. This type of pain, stemming from nerve damage that can be caused by a wide variety of illnesses (including HIV/AIDS, multiple sclerosis, and diabetes) and injuries, is notoriously hard to treat. Standard pain drugs, even opioid narcotics, often provide incomplete relief at best. Sometimes anticonvulsant drugs such as gabapentin can be helpful, but some patients do not respond or cannot tolerate these medications. The need for better treatments is universally recognized.

Trial Results

The first human trial of marijuana for HIV-associated neuropathy, conducted by Donald Abrams and colleagues at the University of California, San Francisco, was published in Neurology in February 2007. Abrams compared smoked marijuana to placebo (marijuana with the cannabinoids removed) in patients who had a chronic pain score of at least 30 on a 100-point scale. The first marijuana cigarette reduced pain 72%, compared to just 15% with placebo. No serious adverse events were reported, and while some experienced the side effects one would expect (like dizziness or disorientation), these were mild enough that the researchers concluded that they “do not represent any serious safety concerns in this short-term study.”

A second HIV neuropathy study, out of UC San Diego and published in 2008 by Neuropsychopharmacology, focused on patients for whom at least two classes of analgesic drugs had failed. Again, smoked marijuana was, as the study concluded, “generally well-tolerated and effective... cannabis was associated with a sizeable (46%) and significantly greater (vs. 18% for placebo) proportion of patients who achieved what is generally considered clinically meaningful pain relief.”

A third University of California study, also published in 2008, found smoked marijuana effective for relief of neuropathic pain from a variety of non-HIV causes, including multiple sclerosis and spinal cord injury. Notably, the researchers explained, “cannabis does not rely on a relaxing or tranquilizing effect (e.g., anxiolysis), but rather reduces both the core component of nociception and the emotional aspect of the pain experience to an equal degree.”

Meanwhile, a 2007 Columbia University study, published in the Journal of Acquired Immune Deficiency Syndromes in August 2007, compared relatively weak marijuana (2.0 or 3.9% THC) with relatively high doses of Marinol (dronabinol), the prescription THC pill. Margaret Haney and colleagues compared the drugs’ effects on a variety of parameters, including caloric intake, weight, mood, sleep, and cognitive performance.

The pill was administered at five or 10 mg four times a day, four or eight times the standard dose for appetite stimulation.

Both treatments were rated as effective, but the 3.9% THC marijuana outperformed even the highest dose of dronabinol at stimulating hunger/desire to eat, increase in daily caloric intake, sleep duration, and in patients’ self-rated quality of sleep. The researchers also tracked patient requests for over-the-counter medications to treat nausea, diarrhea, and upset stomach, and both marijuana and dronabinol reduced these to almost zero. Strikingly, the article notes no effect on patient performance on a series of tests used to measure psychomotor or cognitive functioning: “Compared with placebo, neither marijuana nor dronabinol significantly altered performance on any of the tasks.”

As Dr. Abrams has been known to observe, it’s not surprising that an herbal medicine that’s been safe and effective for 5,000 years is still safe and effective today. But as the evidence piles up in favor of this natural plant product, the pharmaceutical industry is energetically pursuing its own versions of cannabinoid medicines.

Some, such as GW Pharmaceuticals’ Sativex, are made from the plant, while others are synthetic single cannabinoids. No doubt Western medicine’s preference for single chemical entities—along with politicians’ continuing desire not to recognize anything good about marijuana—will exert a powerful pull in favor of prioritizing these new pharmaceutical products over the plant.

And maybe, someday, Big Pharma will produce a synthetic cannabinoid medicine that works better than Marinol, which is unloved by patients. At that point, the policy question will be this: Is it appropriate for government to push customers toward expensive pharmaceutical products, when many can get adequate and safe relief from a plant they can grow in their own backyard?

The right answer is obvious. What will happen in the real world is less so.

http://www.genengnews.com/gen-articles/medical-marijuana-policy-catches-up-with-science/3156/