Friday, June 7, 2013

Fibromyalgia Pain & Premature Aging

By , About.com GuideJune 3, 2013
"Researchers compared telomere lengths of people with fibromyalgia and healthy controls and found there wasn't a huge difference, overall. However, when they looked at the fibromyalgia participants who had higher pain levels, they found shorter telomeres than in controls or lower-pain patients. Participants who had high pain AND high depression levels had the shortest telomeres, with lengths suggesting they were six years older than their actual age.
Telomere shortness was also linked with low pain threshold and sensitivity, as well as with less gray matter in regions of the brain involved in pain processing. This kind of premature gray-matter loss has been linked to fibromyalgia by earlier research."

Read the entire story HERE.

Friday, May 31, 2013

Does chronic mean forever?

The word "chronic" can be scary, and it's true that both fibromyalgia and chronic fatigue syndrome are considered chronic conditions.

However, that's a far cry from meaning that you'll always be as sick as you are right now.

Medically speaking, chronic means "of long duration." An illness is considered chronic when it has a slow progression and lasts for a long time. True, sometimes it lasts for the rest of a person's life – but not always.Most of us will never get to the point of being symptom free, but we can make real improvements and regain much of what we've lost.

Read the entire story HERE

Friday, May 10, 2013

Inflammation Continues in Chronic Pain Patients


By Ed Susman, Contributing Writer, MedPage Today

NEW ORLEANS -- Even after long-term treatment with opioids, inflammation persists in many chronic pain patients as evidenced by C-reactive protein levels and erythrocyte sedimentation rate, a California researcher reported here.
Of the 40 patients taking high dose opioids, over 100 mg equivalents of morphine a day, 8 individuals (20%) were found to have high levels of the inflammatory markers, said Forest Tennant, MD, director of the Veract Intractable Pain Clinic in West Covina.
"The elevated inflammatory markers suggest that the underlying cause of pain is still active or there may be on-going neuroinflammation related to centralized pain," Tennant stated in his poster presentation at the annual meeting of the American Pain Society.
He also reported that 12 patients had abnormal hormone levels, the most common of which was low serum pregnenolone, found in 4 (10%) of the patients.
"All 40 patients reported sustained pain control on a stable opioid dosage and improvements in one or more physiological functions," Tennant reported. The only category in which patients failed to consistently report better results was for vision, for which 5% of patients said their vision was better and 5% said it got worse. The rest of the patients responding to the questionnaire reported no change in vision.
He evaluated outcomes among 40 patients treated at his clinic between July and October 2012, all of who received high dose opioid therapy for the past 10 or more years. Prior to opioid therapy, all of these patients received multiple non-opioid treatments. Patients claimed constant, debilitating pain with severe insomnia.
The evaluation included two questionnaires; one asked about depression, hopelessness, and quality of life before and during opioid treatment and the other about improvement in 17 physiologic functions.
"Every patient reported improvement in depression, hopelessness, and quality of life," said Tennant.
Patients experienced great improvement in several functions such as: movement, 77.5%; concentration, 67.5%; walking, 62.5%; sleeping, 62.5%; appetite, 50%; memory, 42.5%; reading, 42.5%; and libido, 40%.
Hormonal suppression was a complication in 8 patients: corticotropin (2; 5.0%), cortisol (3; 7.5%), testosterone (2; 5.0%), and pregnenolone (4; 10.0%).
"The high dose opioid patients studied here greatly improved many physiologic functions and mental outlook," he reported.
David Craig, PharmD, clinical pharmacist specialist at Moffitt Cancer Center at the University of South Florida, Tampa, told MedPage Today:
"One of the questions I would have about this study is whether the patients with ongoing inflammation have some underlying condition that is causing the inflammation. If these patients have non-cancer low back pain, for example, then the inflammation finding would be more interesting than if these patients had another condition such as rheumatoid arthritis or lupus."
Craig, a former member of the APS board of directors, also said, "There have been animal studies that suggest that opioids depress immunity, and that may be what this study is getting at, that maybe there is some interplay between the presence of opioids and the depression of the immune system."

Wednesday, April 10, 2013

Chronic pain ranks well below drug addiction as a major health problem in new poll

Contact: Anna Briseno
abriseno@researchamerica.org
571-482-2737
Research!America 

High percentage of Americans concerned about misuse of pain medication

ALEXANDRIA, Va.—April 9, 2013—A new national public opinion poll commissioned by Research!America shows only 18% of respondents believe chronic pain is a major health problem, even though a majority of Americans (63%) say they know someone who experienced pain so severe that they sought prescription medicines to treat it. Chronic pain conditions affect about 100 million U.S. adults at a cost of approximately $600 billion annually in direct medical treatment costs and lost productivity.
Most Americans are concerned about the misuse of pain medication to treat chronic pain. A high percentage (82%) believes that taking prescription painkillers for long-term, chronic pain could result in addiction, which nearly 50% of Americans describe as a major health problem. An overwhelming majority (85%) are very concerned or somewhat concerned that prescription pain medication can be abused or misused. Indeed, 40% believe that prescription medication abuse and addiction is a major problem in their community.

According to the National Institutes of Health, an estimated 1.9 million people are addicted to prescription pain relievers. The number of unintentional overdose deaths from prescription pain relievers has quadrupled since 1999, outnumbering those from heroin and cocaine combined. As drug addiction becomes more prevalent, most Americans are split on whether addiction and chronic pain are getting the attention they deserve by medical researchers, elected officials and media.

"We need to better understand addiction," said Research!America President and CEO Mary Woolley. "We shouldn't shy away from research on new pain treatments based on fears of abuse. The suffering is simply too great. More robust investment in research and the engagement and support of policy makers and health care providers are essential to developing effective strategies to reduce the prevalence of addiction."

Two-thirds of those polled (66%) were unaware that tamper- and abuse-resistant formulations for some prescription pain medications are now available. These formulations of medications have physical and chemical properties that make them more difficult to abuse; for example, making pills harder to crush to inject or snort.
Other poll highlights:
  • 60% say chronic pain tends to be dismissed by doctors and the public.
  • More than half (54%) say doctors are not discussing the possibility of developing dependence or addiction to pain medication enough with their patients.
  • 52% believe doctors should have limits on the amount and dosage of pain medication they are allowed to prescribe.
  • Based on their experience or what they have heard, respondents say they would use the following treatments to try to relieve chronic pain: physical therapy (64%), over-the-counter pain medication (55%), diet or lifestyle change (54%), chiropractor (49%), prescription pain medication (47%), herbal remedies (38%), and acupuncture (36%).
  • When asked what percentage of drug overdose deaths involve physician-prescribed pain medication or prescription medication obtained illegally, responses varied widely. In fact, 75% of pharmaceutical overdose deaths involve an opioid pain medication.
  • Only 4% say it's the responsibility of law enforcement to address the prescription drug abuse problem.
The national public opinion poll was conducted online in March 2013 by Zogby Analytics for Research!America. The poll had a sample size of 1,016 with a theoretical sampling error of +/- 3.1%.
###

About Research!America polls
Research!America began commissioning polls in 1992 in an effort to understand public support for medical, health and scientific research. The results of Research!America's polls have proven invaluable to our alliance of member organizations and, in turn, to the fulfillment of our mission to make research to improve health a higher national priority. In response to growing usage and demand, Research!America has expanded its portfolio, which includes state, national and issue-specific polling. Poll data is available by request or at http://www.researchamerica.org.

About Research!America
Research!America is the nation's largest nonprofit public education and advocacy alliance working to make research to improve health a higher national priority. Founded in 1989, Research!America is supported by member organizations representing 125 million Americans. Visithttp://www.researchamerica.org.

Saturday, March 30, 2013

Suicide and chronic pain

I don't fiend over the stats on my blog like some people do, but I do check them occasionally, and I've noticed a lot of people end up here after "googling" chronic pain and suicide.  Yes, my stats can tell me that, and it is quite disturbing to me.  I sort of feel like I have a responsibility to have something here that is helpful for people in chronic pain who are thinking of taking that step.

I want you to know, there are enough good days to make it worth it, if you can find the right doctor or team of doctors to treat your pain condition.  I understand what it feels like to be so tired of being in pain I don't think I can make it another day.  But I didn't give in to those thoughts, and I have a much better quality of life today than I did then.  And I still have those thoughts at times, but I know that my intense pain episodes will end, and I can have a few good days, or weeks, or even months at a time.

If you are thinking of harming yourself because you are in constant pain, please wait until you can see your doctor before making such a drastic decision.  A person in chronic pain truly is not in a condition to make such profound decisions when in an acute pain episode.  You literally can't think clearly and shouldn't make any major life decisions during this time.  First of all, don't harm yourself.  Next call someone and tell them you are thinking of taking your life.  Preferably a local or national suicide hotline, your physician, or psychologist, or even just a friend if you can't tell anyone else.

One of the things I always think about is the fact that when a person commits suicide, their children are more than twice as likely to take their own lives also.  I just couldn't do this to my children, whom I love dearly, and I don't want you to do this either.  If you don't have children, think about the impact your decision will make on everyone that knows you.  Please visit the suicide hotlines page HERE if you are still thinking of suicide or harming yourself in any way.  You will find national numbers where you can talk to a professional about the issues you are having.

Please feel free to post your feelings and experiences in the comments here on this page.  Sometimes, seeing your thoughts written down can make them real to you and perhaps help you to feel more comfortable calling a hotline number.  

Thursday, March 14, 2013

Nerve damage may underlie widespread, unexplained chronic pain in children

Nerve damage may underlie widespread, unexplained chronic pain in children Some researchers think this may be a new disease.  Go to the link for the entire article.

Small-fiber polyneuropathy (SFPN) involves widespread damage to the type of nerve fibers that carry pain signals from the skin and also control autonomic functions such as heart rate, blood pressure and sweating. Most commonly associated with diabetes, SFPN can be caused by other disorders in older adults or by exposure to toxic substances. Typical symptoms include chronic pain in several parts of the body, often beginning in the feet or lower legs, along with symptoms of autonomic dysfunction such as gastrointestinal problems, dizziness or fainting when standing, rapid heart rate, and changes in the appearance of skin. Specific diagnostic criteria have been established for SFPN, and accurate diagnosis can guide app

Tuesday, February 19, 2013

Today's a bust

This entire day has been an absolute bust.  I've done almost nothing except sit in my recliner and use my netbook (it is easier on my hands and wrists because it is lighter than a laptop).

On days like today I feel that my body and I are on opposite sides of some great war.  I want to try and make the pain separate from my body.  This gives me some hope that things will get better if I  keep fighting for the energy just to exist.

This is merely a psychological game that gets me through especially rough spots.  In reality if there were anything I could do to make it better, I would have already done it.  If I don't feel like I have some hope of getting better soon, my mind just can't accept it.

Tuesday, February 12, 2013

Israel's medical marijuana industry produces scientific results


The Quiet Giant: Israel’s Discreet and Successful Medicinal Cannabis Program

by Lindsay Stafford Mader

HerbalGram. 2012; American Botanical Council

Link to original article


Despite its status as one of the world's leading nations for medical research and innovation, the United States has a remarkably restrictive system in place to regulate medicinal cannabis research. Even when the US Food and Drug Administration (FDA) approves medicinal cannabis studies, the researcher or institution must then obtain approval from the Public Health Service (PHS), as well as procure cannabis material from the National Institute on Drug Abuse (NIDA), which has a monopoly on the supply of cannabis that can be used for research throughout the entire country.1 Cannabis (Cannabisspp. Cannabaceae) is the only scheduled substance for which PHS approval is required, and those wishing to study the plant often have been rejected by the agency — effectively quelling this important area of science. An increasing number of US states have taken matters into their own hands by legalizing medicinal cannabis for residents with certain health conditions. But the federal government continues to raid and shut down state-based medicinal cannabis operations, even sending some of these business owners to prison. Although the US situation is largely based on the discrepancy between state and federal law, Americans and citizens of other countries that ban medicinal cannabis could learn just how successfully, compassionately — and non-controversially — such a program can be handled by looking at the unique national medicinal cannabis program in Israel.
Path to Medicinal Access
The Israeli government always has classified cannabis as dangerous and illegal, and it remains a crime to use the herb recreationally and without a license from an approved physician. Unlike US state-based medicinal cannabis initiatives, the nationwide program in Israel has won growing support from government officials, inciting relatively little controversy among Israeli citizens, public officials, and religious leaders.2  

In 1995, the Israeli Parliament Drug Committee formed a subcommittee to examine the legal status of cannabis, which recommended that the government continue to categorize cannabis as illegal, but also that it allow and regulate access to medicinal cannabis for severely sick patients.2,3

“The second recommendation was of course extremely positive and important,” said Boaz Wachtel, a medicinal cannabis activist in Israel who served as one of two public representatives on the committee (email, November 29, 2012).3 “For the first time a Parliament-nominated committee acknowledged the medical use of cannabis and created an opening to advance the subject.”

Wachtel noted other important factors behind the committee’s recommendations, including the US Food and Drug Administration’s 1985 approval of the synthetic THC-containing drug Marinol®, as well as input from Raphael Mechoulam, MD, who also served on the committee. Dr. Mechoulam, a Bulgarian-born Israeli scientist, isolated tetrahydrocannabinol (THC) in 1964.2 In 1992, Dr. Mechoulam and colleagues Lumír Ondřej Hanuš and William Anthony Devane isolated and described anandamide, a endogenous cannabinoid neurotransmitter in the human brain.4

“I assume that the successful cannabis research in Israel has had some impact on the decision by the Ministry of Health to proceed with a carefully regulated medical marijuana program,” said Dr. Mechoulam (email, December 6, 2012). “The committee I chaired in 1995 consisted mostly of government officials. Their overall attitude was quite liberal. We tried to minimize criminalization and to find ways to legalize medical use. Our report was never discussed or approved, but I am under the impression that it affected the attitude of the police and the Attorney General.”

Several societal and political forces also were at play before and during the Israeli government’s cautious but genuine interest in medicinal cannabis, said Rick Doblin, PhD, executive director of the California-based Multidisciplinary Association for Psychedelic Studies (MAPS), who has collaborated with the Israelis on medicinal cannabis and MDMA (also known as ecstasy) research. For one, Israel’s most important ally, the United States, is opposed to medicinal cannabis and Israel did not want to compromise that relationship. On the other hand, there is the deep, fundamental Jewish principle to ease suffering, which many saw cannabis as doing.

“Also the fact that Mechoulam is from Israel and they had this tradition in being world leaders in cannabinoid research, they put their toe in the water,” said Dr. Doblin (oral communication, December 4, 2012). “They did see that there is an awful lot of suffering that marijuana can help reduce at a very low cost.”

When considering a national program, the Israeli Ministry of Health (MOH) consulted with Dr. Doblin and MAPS and a few additional medicinal cannabis groups on programs in other countries. Israel strived to comply with international drug treaties, particularly the 1961 United Nations Single Convention on Narcotics, which “aims to combat drug abuse by coordinated international action” and limits narcotic drugs to medical and scientific use.5 Among several provisions on medical usage in the 44-page document, the Single Convention calls for limiting “the cultivation, production, manufacture, and use of drugs to an adequate amount required for medical and scientific purposes, to ensure their availability for such purposes and to prevent illicit cultivation, production and manufacture of, and illicit trafficking in and use of, drugs.” (Interestingly, this is the very same treaty that the United States has used to argue in favor of its stifling monopoly on cannabis research supply.1)

“The Israelis have been quite aware of the obligations of the Single Convention and the different ways it has been interpreted around the world,” said Dr. Doblin. “They could see that even though the US wasn’t willing to go that far on a federal basis, that there were states that were going this far and also other countries, like the Netherlands and Canada. That helped them to feel more comfortable because what we were able to show them is that the International Narcotics Control Board — which evaluates compliance with international treaties, particularly the Single Convention — had never censured any of the countries or spoke out against them.”

Despite Israel’s initial concerns for compromising its strong relationship with the United States, Dr. Doblin noted that he has seen no evidence of such backlash. “None at all,” he said.
To satisfy an important Single Convention requirement for one specific agency to oversee certain functions related to the medicinal use of prohibited drugs, Israel appointed its MOH to lead the country’s medicinal cannabis program.Still, implementation was slow and measured. In 1996, Wachtel met with an MOH official to discuss the implementation of the cannabis subcommittee’s recommendations, and he also submitted a request to supply an HIV patient with medicinal cannabis.

“He said, ‘You have opened an important but controversial door — find a way to implement the program that would not cost the Ministry any money,’” said Wachtel, recounting the official’s response. “Supplies were a problem. The police [were] not willing to provide the cannabis confiscated from the black market. The patients need a few strains of standardized, organic product that will not damage their weakened immune systems. The MOH did not have an answer at this point.”

About two years later, the MOH permitted several patients to grow a few cannabis plants in their own homes, but most became too sick to attend to the plants and an accusation arose that the HIV patient was selling cannabis to minors.3 As a result of these initial roadblocks, the MOH did not issue any additional medicinal cannabis prescriptions for two years. It considered importing cannabis, but due to concerns regarding cost and Single Convention limitations, officials eventually decided to allow a young Crohn’s Disease patient to grow cannabis for himself and the other six patients who were licensed at the time. He also became too sick to grow. With the MOH still unsure of exactly how to implement large-scale production of medicinal cannabis, the program experienced several years of little action.

“The breakthrough occurred when the MOH appointed Dr. Baruch as the new Deputy Director specifically to deal [with] the issue of medical cannabis,” said Wachtel. “The final decision to approve requests from patients and move the program forward was in his hands.”
Modern Evolution of Israel’s Medicinal Cannabis Program
Israel’s medicinal cannabis program has evolved ever so slowly with each passing year. During its first decade, the government issued only 62 prescriptions. Now about 9,000 medicinal cannabis prescriptions are currently active, said Yehuda Baruch, MD, the former head of the program (email, December 4-16, 2012).

“The vision [has been] to help those in need when there is no other viable option [at] an affordable price and with as little bureaucracy as can be,” said Dr. Baruch, who is also a psychiatrist and director of the Abarbanel Mental Health Center in Bat Yam. The widespread relief medicinal cannabis can provide to many patients does not come without the paradoxical negative, from Dr. Baruch’s perspective, that the same patients also achieve a recreational high. “The increasing number [of permits] is both a point of concern because the main source today for recreational use is medical cannabis, but also a blessing because it is one more medicine in the pharmacopeia that can be used when all else has failed, and since it works by a different mechanism of action, it may prove successful.”

Dr. Baruch led Israel’s medicinal cannabis program for a decade, from 2002 until December 2012. (Although his replacement has not been publicly announced, sources for this article have indicated it is Yuval Lanshaft, a former high-ranking Internal Security officer.) For several years Dr. Baruch was the only physician in the entire country allowed to issue patient licenses, and he also was in charge of organizing and leading the program along with the Ministry of Agriculture, Homeland Security, and the customs office.

“I personally lectured in every academic or medical meeting that was possible, even if it was a very small one,” said Dr. Baruch, “and gave my private phone number and an invitation to call on anything. I also worked closely with relevant politicians and discussed the subject in the Israeli parliament various times. All in all, a lot of leg work.”

In 2010, the MOH decided to allow additional physicians in five hospitals to provide medicinal cannabis licenses to patients, lifting the heavy responsibility from Dr. Baruch and enabling somewhat faster and easier patient access to the herb.6Currently, nine physicians are permitted to share this load. Dr. Baruch noted that while all senior physicians in the country can request a license for any number of their patients who might benefit from medicinal cannabis, only these nine MOH-appointed physicians are allowed to approve and issue permits. Because cannabis can be prescribed only as a “last resort” medicine, patients usually are told about it while they are in emergency rooms and oncology and pain wards, and the requesting physician must state that all drug treatment used thus far has been unsuccessful.7

While the increase to nine physicians was an improvement, Dr. Doblin noted that having this few prescribing doctors might impose burdensome limits on a nation of patients (news reports have referenced a MOH study that found 40,000 Israelis could benefit from cannabis8).

“I think that right now [Israel’s program] is a tremendous success,” said Dr. Doblin. “It’s too limited, I would say, because there are a lot more people that could benefit. The Ministry is keeping a fairly solid control over the growth of the program. But in the Israeli context, I think that prevented a backlash, so maybe that was the right approach at the time. Still, it’s not the best approach since patients are not currently permitted access for [post-traumatic stress disorder] and other conditions.”

Initially, patients could obtain medicinal cannabis licenses only for asthma, and years later additional conditions were accepted, including AIDS wasting syndrome, vomiting and pain associated with chemotherapy for cancer, and all other applications were considered on a case-by-case basis, said Dr. Baruch. Now patients with the following conditions are considered for prescriptions:
   Chronic pain due to a proven organic etiology
   Orphan diseases (i.e., diseases and conditions that affect only a small percentage of the population and for which few, if any, pharmaceutical drugs are developed)
   HIV patients with significant loss of body weight or a CD4 cell count below 400
   Inflammatory bowel disease (but not Irritable Bowel Syndrome)
   Multiple sclerosis
   Parkinson’s disease
   Malignant cancerous tumor in various stages.9
As of 2011, most patients using cannabis had chronic pain, closely followed by cancer-related conditions.9

For many years, the MOH struggled to achieve a cultivation and distribution system that satisfied government officials as well as patients. In 2007, Dr. Baruch licensed one individual in Israel to grow about 50 cannabis plants to provide material to patients free-of-charge.3 The man, Tsachi Cohen, did so in his parents’ house in northern Israel. The garden was attended and cared for by his mother, a former biology teacher. Eventually, Dr. Baruch licensed several other growers, none of whom were allowed to sell the cannabis for a profit. Many sources interviewed for this article indicated that the initial nonprofit model contributed to the program’s success and acceptance.

“The first feel that the public got was that these are people acting in the public interest and not for personal gain,” said Dr. Doblin.

This small-scale operation by the Cohen family eventually grew into the country’s first, and currently the largest, production center, called Tikun Olam (the Hebrew term based on the Jewish principle that all people should try to repair the broken fabric of the universe through acts of kindness, compassion, healing, and justice). Ultimately, all of the growers’ nonprofit model — which relied mainly on donations — could not be sustained due to the increasing number of licensed patients and the intensive and expensive process required for cultivating high-quality cannabis on a large scale. So the government began requiring licensed growers to charge patients a monthly fee of 360 Israeli New Sheqels (approximately $100 USD) for up to 100 grams per month. The initially prescribed monthly dosage is 20 grams, with 42 grams being the average amount, and every patient is charged the same fee every month, regardless of how much cannabis they receive.8 The price is relatively inexpensive when compared to cannabis in other countries, and several large Israeli medical insurance companies, the Holocaust Survivors fund, and the Ministry of Defense (for some patients with post-traumatic stress disorder) partially cover the cost of medicinal cannabis. 

“The most important [milestone] was the transition from nonprofit to for-profit,” said Dr. Doblin, whose MAPS organization had donated about $85,000 to support the nonprofit facilities. “You could say it was a transition from a non-sustainable model to a sustainable model. Another point that makes Israel so astonishingly successful as a model is that some of their health insurance companies cover marijuana. That’s the kind of information that really needs to get out in America. That for whatever reason, we have insurance companies deciding it is a smart investment to cover medical marijuana. Israel is the only place I know of where that happens.”

There are currently seven licensed growing centers that distribute medicinal cannabis on-site, through home deliveries, in small dispensaries in a limited number of urban locations and hospitals, or at one of the larger distribution centers.9 The central distribution center, named MECHKAR, a Hebrew acronym meaning research, represents an important aspect of the Israeli program. At MECHKAR, patients not only obtain cannabis, but also are welcomed to be trained and counseled on topics such as which strains and dosage forms might be best for their particular condition and lifestyle; levels and location of pain and any other health conditions; and emotional or religious concerns and experiences.10 Staff also closely supervise patients throughout the first few months with feedback forms and meetings in order to optimize dosages, reduce any unwanted side effects, and discuss potential drug interactions.

“We may be the only government on earth right now where patients are sent to use marijuana who have absolutely no desire to use it,” said Mimi Peleg, the director of large-scale training at MECHKAR (email, November 29, 2012). “They do have a strong desire to stop suffering, of course. My first job as a trainer is to relax them enough to even consider the idea that it is okay to use this medication. Working with patients who receive cannabis has taught me that the quality of education that is shared at the beginning of the treatment is an important factor in leading to an optimal control of symptoms.”

From time to time, the MOH discusses the possibility of importing medicinal cannabis from the Netherlands, and it is currently in the process of setting up a large, multi-institutional ministerial Medicinal Cannabis Agency to handle all aspects of medicinal cannabis production, dispensing, testing, and licensing.The government also has been discussing pharmacy distribution to begin sometime in 2013, but it is unclear if this initiative will actually be implemented on time.6 If this step is taken, it is anticipated that the large government agency will purchase all cannabis material from growers, store it in government-controlled warehouses, and then distribute it though pharmacies.9

“As a cannabis trainer, this shift will impact my current role,” said Peleg. “By and large, I think it is a positive move in the right direction. I [still] see the need for some distribution centers where patients can go for further training and strain adjustments. Treating people with cannabis requires much more than just purchasing medicine at a pharmacy.”10

Cannabis is available to patients in a variety of forms such as baked goods, ready-made cigarettes, oils, and tinctures.10Patients with a medicinal cannabis license also are allowed to ingest cannabis through Volcano® Vaporizers, a device typically costing $500-600 USD retail that heats the cannabis without burning it so that no smoke and reduced amounts of combustion byproducts are produced. Several Israeli health insurance companies and patient care groups also cover some of the price of purchasing or renting a Volcano, which has been licensed by the MOH and approved by the Israel Standards Institute, and several devices donated by Volcano Medic in Israel are available in four public hospitals for patients who cannot afford their own.

“All this has been a huge cooperative effort,” said Peleg. “They put four Volcanos in major hospitals and patients with licenses can request private mouth pieces and balloons or take their own Volcanos in. I did when I was healing from cancer and thereby avoided needing morphine in recovery! It was wonderful to have the choice.”
For all the bold measures taken with medicinal cannabis in Israel, it remains a largely non-controversial situation. The diverse range of patients helped by the herb includes former soldiers, police officers, settlers, Arab Israelis, and elderly Holocaust survivors. Dr. Doblin mentioned that religious leaders have declared cannabis kosher, and Peleg noted a religious, political, gender, and age diversity among the hundreds of patients she has trained over the years.

“A month after her initial training, Hanna* came back in with [her husband] Hiem*, and as is often the case, I barely recognized them,” said Peleg of a Holocaust survivor whom she trained to use medicinal cannabis for pain.10 “There was an undeniable intimacy between them that had been absent in their prior visit — clearly they had been doing some communicating. Instead of being happy, Hanna was livid and for all the right reasons. She wanted to know who to blame for the fact that she hadn’t been given this medication years ago if it had been known and available. Again, who could blame her? Her pain was gone, she had an appetite, she was communicating with loved ones — cannabis was doing its job. Israel is a very small country. We are only 8 million citizens. Word spreads fast and the pressure on the system is extremely high due to stories like Hanna’s that highlight efficacy.”

Cannabis activist Wachtel also noted the late-1980s discovery of ancient cannabis material in a burial tomb in Israel, which researchers postulated was likely given to a 14-year-old girl, also found in the tomb, to “facilitate the birth process” of her unborn child.11 “Cannabis,” said Wachtel, “is therefore viewed here as an indigenous medicinal plant, one that was out of use for a while but is now back in its natural place in the modern pharmacopoeia to alleviate a great number of medical symptoms.”

Even with relatively little controversy, Israeli police allege that cannabis fields attract criminals who steal plants to sell on the black market.12 But Wachtel noted that very little diversion is taking place because the growing operations are typically secured by cameras and armed guards.

Supporters of medicinal cannabis in Israel also see areas where the program can be improved upon. Peleg noted the need for a national strain bank, retrospective assessments of medicines used concurrently with cannabis, a broadened list of diseases, and a more comprehensive training program for medical professionals and patients. Additionally, the process of requesting cannabis and obtaining a physician recommendation and official patient license, while sometimes quick, also can be very lengthy.13

“The system is bursting at the seams,” said Peleg. “If 10 more people worked in the MOH just on cannabis, we couldn’t do all the work that needs to be done.”

Dr. Doblin stressed the need for Israel to produce official medical-grade cannabis supported by Good Manufacturing Practices, thorough documentation, and product standardizations. Even though several Israeli health insurance companies already cover cannabis without it having been through the formal drug-approval process, he noted the possibility of importing medical-grade cannabis from Israel into the United States to support scientific research. (Dr. Doblin’s FDA-approved research that seeks to develop the plant into an approved prescription medicine has been rejected by the PHS/NIDA process.1)

That Israel’s government is generally far more accepting of the herb’s potential as a medicine has enabled a much freer cannabis research community. Dr. Mechoulam, for example, has been obtaining hashish (a preparation made from compressed THC-rich resinous material) from the Israeli police for more than 40 years, with MOH approval. 

“Research in Israel is highly respected and neither the police nor the Ministry of Health have ever raised any major problems,” said Dr. Mechoulam. “They have been, and still are, very helpful. This is true for both basic and clinical research.”

“The benefit of a program like Israel’s is that the government takes a role in ensuring quality and safety of the product, and supports research to further the understanding of the plant’s medical benefits, said Amanda Reiman, PhD, California policy manager for the Drug Policy Alliance (email, December 1, 2012). “In the US, the government has actively prevented research from taking place, and has threatened municipalities that attempt to regulate the quality and safety of the product with criminal prosecution.”

* Names have been changed to protect patients’ privacy.

References
1. Stafford L. The state of clinical cannabis research in the United States. HerbalGram. 2010;85:64-68.
2. Brinn D. A growth sector. Jerusalem Post. March 19, 2009. Available at: www.maps.org/media/view/a_growth_sector/. Accessed December 17, 2012.
3. Wachtel B. Medicinal cannabis in Israel. September 2011 [unpublished].
4. Wisneski L, Anderson L. The Scientific Basis of Integrative Medicine, 2nd ed. CRC Press; Boca Raton, Florida. 2009. 
5. Single Convention on Narcotic Drugs, 1961. The United Nations. Final act of the United Nations conference for the adoption of a Single Convention, as amended by the 1972 Protocol amending the Single Convention on Narcotic Drugs, 1961. Available at: www.unodc.org/pdf/convention_1961_en.pdf. Accessed December 17, 2012.
6. Siegel-Itzkovich J. More MDs to get licenses to prescribe medical marijuana. Jerusalem Post. September 6, 2010. Available at: www.jpost.com/HealthAndSci-Tech/Health/Article.aspx?id=187221. Accessed November 27, 2012.
7.  Mechoulam R. Israel: legal aspects of marijuana use, medical use. October 20, 2008. International Association for Cannabinoid Medicines. Available at: http://cannabis-med.org/index.php?tpl=page&id=45&lng=en&sid=1b35fdd1438521c70b7a145c6cf33ffb. Accessed December 17, 2012.
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Sunday, February 10, 2013

Doctor pioneering the use of new painkiller


Link to original story Here

Mill Valley doctor pioneering the use of new painkiller for chronic pain, says it's safer




Howard Kornfeld M.D. talks to patient Tony Perniconi on Thursday, Jan. 31, 2013, in Mill Valley, Calif. The doctor has pioneered new methods of pain management using a substance called Buprenorphine as a substitute for Vicodin and Oxycontin. (IJ photo/Frankie Frost) Frankie Frost


At a time when the nation is dealing with an epidemic of prescription painkiller abuse, a Mill Valley physician, Dr. Howard Kornfeld, is championing the use of a painkiller little known in the U.S. that features a greater margin of safety for both overdose and addiction.

According to the Centers for Disease Control and Prevention, there is currently a "growing, deadly epidemic of prescription painkiller abuse." The CDC says there has been a 300 percent increase since 1999 in the sale of strong prescription painkillers, such as Vicodin and OxyContin. The CDC estimates these prescription painkillers were involved in 14,800 overdose deaths in 2008, more than cocaine and heroin combined,
and more than 475,000 emergency department visits in 2009, a number that nearly doubled in just five years.


Late last month, a Food and Drug Administration advisory panel voted to impose tighter controls on prescriptions for drugs like Vicodin, which contain the opioid pain reliever hydrocodone.

For the past 20 years, Kornfeld has operated a medical clinic in Mill Valley where he treats patients for chronic pain, chemical dependency and prescription medication management issues. In 2011, Kornfeld also helped establish the first pain management clinic at Highland Hospital in Oakland. At both clinics, Kornfeld has pioneered the use of buprenorphine, a semi-synthetic opioid created in England in the early 1970s, for the treatment of chronic pain.


"Myself and a handful of other doctors around the country are trying to get the word out that is a good way to go," Kornfeld said.

Kornfeld said he first became aware of buprenorphine in the 1990s when he was treating heroin addicts and prescription drug addicts. "We heard that the French had turned their addiction problem around with buprenorphine," he said.

At that time, buprenorphine was licensed for use in the United States only for the treatment of pain and could only be administered by injection; but it was little used.  Kornfeld said, "So since we had patients who had chronic pain, some of whom also had addictions, we decided to pioneer the use of buprenorphine in the U.S. for chronic pain."

Kornfeld also discovered he could legally have several pharmacies convert the buprenorphine into a compounded form that could be dissolved in the mouth.

Unlike heroin and other opiate derivatives, buprenorphine does not make its users euphoric and is unlikely to cause a lethal overdose by depressing respiration.

"If a person is already dependent on an opiate, they don't feel any high from buprenorphine," Kornfeld said. "Whereas with OxyContin, methadone, morphine, and Vicodin

Howard Kornfeld M.D. examines patient Tony Perniconi on Thursday, Jan. 31, 2013, in Mill Valley, Calif. The doctor has pioneered new methods of pain management using a substance called Buprenorphine as a substitute for Vicodin and Oxycontin. (IJ photo/Frankie Frost) Frankie Frost
there is a tendency for people to double or triple their dose and feel some kind of euphoria and then fall into addiction."


Kornfeld said if someone takes too much buprenorphine, they will become very sleepy; but the drug won't kill them.

Patients can become addicted to buprenorphine; however, withdrawal from the drug is much milder than with other opiates.

"You're not going to be roaming the streets in six or eight hours looking for another fix," Kornfeld said.

Tony Pernicone, a fine art dealer, auctioneer and appraiser who lives in San Rafael, credits Kornfeld and buprenorphine for enabling him to regain his health after years of struggle.

Pernicone, 61, said since he was a teen-ager he has struggled with kidney stones and the intense pain that accompanies their production. In addition to producing 20 to 30 kidney stones during his lifetime, Pernicone has also overcome colon cancer, diabetes and other medical maladies.
"My medical record is thicker than the Bible," Pernicone said.

By the time Pernicone was diagnosed with colon cancer in 2007, his weight had ballooned to 350 pounds, and after a baseball-sized tumor was removed, doctors advised him against chemotherapy, fearing he lacked the strength to survive it.

Pernicone said that when he first sought Kornfeld's help he was taking the maximum possible dose of OxyContin. "It was really unbelievable how I was even talking," he said. "Because of the traditional pain meds I wasn't really in a state of mind where I could recover."

Kornfeld used buprenorphine to help Pernicone stop taking other prescription painkillers.
Pernicone said, "There is no euphoria. It just manages to stop the pain receptors. With that I was able to start exercising and get back into shape. I've lost over 150 pounds."

Kornfeld said one of the reasons that buprenorphine isn't better known is that no drug company is marketing it aggressively.

"Pharmaceutical companies view the painkiller market as a huge potential market," Kornfeld said. "They want to invent new drugs that can be patented and buprenorphine at this point, except in certain specific forms, is a generic drug. Huge amounts of money could be saved by moving people from OxyContin to buprenorphine."

Highland Hospital, where Kornfeld treats patients twice a week, is the medical center of last resort for thousands of low-income and medically indigent patients. Kornfeld said he started his clinic there because the goal of the Alameda County Medical Center was to reduce patients' dysfunctional dependence on opiates.

"Dr. Kornfeld has enormous passion for this issue," said Dr. Evan Seevak, Medical Director for Ambulatory Care at Alameda County Medical Center. "By using buprenorphine, we've been able to get people off a lot of the other pain medicines they've been using and get them on just a single medicine at a stable dose."

Contact Richard Halstead via e-mail at rhalstead@marinij.com

Cymbalta withdrawal

I have been taking Cymbalta for chronic pain for a few years now.  Due to a problem with the pharmacy's communication with me, my refill will not be ready for another few days.  I am in the middle of horrible withdrawal symptoms.  I ran out of my Cymbalta about a week before the pharmacy will end up mailing me the refill.  I had no idea that the withdrawal symptoms from the drug are so intense and wretched. 

I have constant uncomfortable tactile sensations, a profound rebound issue with my pain level, and projectile vomiting to mention just a fraction of the symptoms.  Most disturbing is I can feel what seem to be electrical pulses shooting up and down my cervical spine and in my head.

I can guarantee you I will try very hard not to run out of this med again.  It's been a week already and the symptoms show no sign at all of decreasing in intensity.  I can only imagine what sort of haywire my brain chemistry is going through.

Just thought it would be important for people to know this in case they are taking or thinking of taking Cymbalta.