Cannabis is a First-Line Treatment 

Cannabis is a First-Line Treatment 
Posted by CN Staff on July 08, 2006 at 11:27:43 PT
By Dr. Tod Mikuriya
California -- In 1996, California legalized cannabis as a treatment for "any... condition for which marijuana brings relief." Although the law does not constrain physicians from approving the use of cannabis by children and adolescents, the state medical board has investigated physicians for doing so, exerting a profoundly inhibiting effect.Even doctors associated with the Society of Cannabis Clinicians have been reluctant to approve cannabis use by patients under 16 years of age, and have done so only in cases in which prescribable pharmaceuticals had been tried unsuccessfully.
The case of Alex P. suggests that the practice of employing pharmaceutical drugs as first-line treatment exposes children gratuitously to harmful side effects.Alex P., accompanied by his mother, first visited my office in February 2005 at age 15 years, 6 months. At that time he had been prescribed and was taking Fioricet with codeine (30 mg, 3x/day); Klonopin (1 mg, 2x/day); Ativan (1 mg, 2x/day); and Dilaudid "as needed" to treat migraine headaches (346.1), insomnia (307.42), and outbursts of aggression to which various diagnoses -including bipolar with schizophrenic tendencies- had been attached by doctors in the Kaiser Healthcare system.Alex had previously been prescribed Ritalin, Prozac, Paxil, Maxalt, Immitrex, Depacote, Phenergan, Inderal, Thorazine, Amitriptaline, Buspar, Vicodin, Seroquel, Risperdal, Zyprexa, Clozaril, Norco, and Oxycodone.A history taken from Alex and a separate interview with his mother, Barbara P., were in full accordance. The mother described Alex as a healthy baby who was "never a good sleeper." She had "a rocky relationship" with Alex's father, who had three children from a previous marriage. Alex, their second son, "always saw himself as the peacemaker when there was arguing... I think that's why, when it was time for him to go to school, he never wanted to go. He just didn't like to leave the house."Although Alex showed facility communicating verbally, his reading and writing skills disappointed his teachers and prior to going to middle school he was evaluated for an Individual Educational Plan.According to his mother, "They didn't say he was dyslexic, they said he 'had trouble processing things.' He wasn't acting wild in school. He was always well behaved. But they said he had ADD because he couldn't concentrate and process things." At age 11, Alex was prescribed Ritalin for attention deficit disorder.In middle school Alex befriended some 13- and 14-year-olds, with whom he was caught stealing a car (and with whom he had shared his stimulant medication, and who introduced him to marijuana). Thus began a four-year sojourn through institutions of the Central Valley juvenile justice system and Kaiser-affiliated hospitals and clinics.In this period, according to Barbara P., "They put him on all these medications and not only couldn't he sleep at night, but he started having rampages, hitting -mainly me. He fought with his brother and his dad, too. He beat up the truck. He couldn't remember afterwards what he actually did. He seemed like a completely different person. I don't think that's because of who he is. I think it was because of the medications he was taking." Barbara P. expresses remorse that she obeyed court orders to force Alex to take his prescribed medications.At age 13 Alex made a serious attempt at suicide by hanging himself from a tree outside his house. He was rescued by his brother returning home unexpectedly. He reports making other attempts to overdose on pills.Alex had known since age 11, when he first smoked cannabis with his older friends, that it had a calming effect. Many of his encounters with the juvenile justice system were for marijuana possession. His mother says, "He was aware that it helped him not feel stressed out and not have headaches. It helped him concentrate. It helped him sleep. All the things he needed. But I wasn't for smoking it." She reports feeling social pressure from her Central Valley community and pressure from her husband to oppose Alex's attempts to obtain and use marijuana."Alex went through three rehabs--two inpatient and one outpatient, all court-ordered, all for marijuana. He could not do inpatient and I told them that. It's not that Alex wanted to be out there doing drugs, he wanted to be home! He had a thing where he didn't want to be put in an institution where he didn't know anybody. That would drive him more crazy. He ended up running from one rehab house and getting kicked out of another."Perceiving that Alex's mental state was worsening, and in response to his repeated requests to be allowed to smoke marijuana, Barbara did research on the internet that alerted her to similarities between cannabis and Marinol (dronabinol), a legally prescribable drug. Her request that a Kaiser physician prescribe Marinol for Alex was rejected.Through the internet she identified the author as a specialist in cannabinoid therapeutics and arranged an appointment for Alex.A prescription was written in February 2005 for Marinol (10 mg), along with a recommendation to use cannabis by means of a vaporizer. Alex has consistently maintained he prefers smoking cannabis to ingestion by other means, due to rapidity of onset and ability to titrate dosage. ("It works great and you can use just as much as you need," he says.)When a drug test ordered by the Probation department turned up positive for cannabinoids, Alex had a hearing at which a Superior Court judge declared that because Marinol use could mask marijuana use, he would not allow it. He explicitly refused to recognize the validity of a specialist in the field of cannabis therapeutics and ordered Alex to take only drugs prescribed by Kaiser. Barbara P. says: "I guess judges have authority over anything. He thought Alex had a drug problem with marijuana because he had smoked it before." At a subsequent hearing another judge rescinded the order. When Alex's Probation ended in May, 2005, he began medicating exclusively with smoked cannabis.  Dramatic Improvement Alex and Barbara P. were seen by the author at a follow-up visit in February 2006. Alex reported dramatically improved mood and functionality with only one migraine attack in the past year, not severe enough to require a trip to the hospital for a Dilaudid injection. He is in an independent study program at a small public school and getting straight As and Bs. "They love me at school," Alex asserts. His teacher is aware that he medicates with cannabis with a physician's approval. He smokes approximately one ounce per week and would use 50% more if it were cheaper to obtain. He does not vaporize because a vaporizer is "too expensive" (although he has taken up the guitar and purchased several models). He summarizes his status thus: "I use(d) to use a lot of medication like Klonopin and other pain medication but I haven't had to since the use of cannabis."His mother reports: "We knew after about three months on Marinol that he was going to be okay. He started doing a lot better. He sleeps well, he's not on any of the other medications, I haven't had to take him to the emergency room for migraine since he first went on Marinol. He's been totally fine. He walks the dog, cleans up his room, does chores for the family. And I know that he's going to be okay. Before, I never knew what was going to happen. I couldn't picture him getting a job." Alex's father has relented in his disapproval of Alex's cannabis use, having seen its effects on the household. The case of Alex P. is one of iatrogenic illness in which drug-oriented school counselors and administrators played a harmful role. In a previous era, psychologists would have put more emphasis on examining the family constellation. An adequate work-up would have identified Alex's insomnia as the likely cause of his poor scholastic performance. Failing an adequate work-up, the quasi-diagnosis "inability to process" led to a prescription of methylphenidate, a stimulant, for an 11-year-old with persistent insomnia. The resulting disinhibition led in turn to trouble with law enforcement, a cycle of extreme anxiety and distress, and the prescription of more drugs, irrationally chosen to counteract drug-induced symptoms.As a result of the federal prohibition, there exist no official guidelines governing when and how cannabis should be used by patients suffering from a given condition. The Institute of Medicine Report of 1999 acknowledges the feasibility of cannabis being used to treat certain conditions when all pharmaceutical options have failed. The case of Alex P. suggests that employing pharmaceutical stimulants, antidepressants and anti-psychotics exposes children gratuitously to harmful side effects in violation of Hippocratic principles. The first-line treatment for any condition, efficacy being equal, would be the drug or procedure least likely to cause harm. Given the benign side-effect profile of cannabis, it should be the first-line of treatment in a wide range of childhood mental disorders, including persistent insomnia.Physicians and parents both face stigma and take risks in authorizing cannabis use by children, but the risks are legal and social rather than medical. The case of Alex P. exemplifies this reality. Note: Why Judges Shouldn't Have Control Over Everything.Complete Title: Cannabis is a First-Line Treatment for Childhood Mental DisordersSource: (CA)Author: Dr. Tod MikuriyaPublished: July 8 & 9, 2006Website: counterpunch counterpunch.orgURL: H. Mikuriya, MD Medical Marijuana Archives
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Comment #13 posted by FoM on July 08, 2006 at 22:39:36 PT
Related Article from
Big Pharma's Strange Holy Grail -- 
Cannabis Without Euphoria?***By Fred GardnerWeekend EditionJuly 8 / 9, 2006The International Cannabinoid Research Society held its 16th annual meeting June 24-28 at a hotel on the shores of Lake Balaton, about 80 miles southwest of Budapest. Most of the 350 registrants were scientists -chemists, pharmacologists- employed by universities and/or drug companies. The sponsor given top billing was Sanofi-Aventis, manufacturer of a synthetic drug, known variously as "SR-141716A," "Rimonabant," and "Acomplia," that blocks cannabinoid receptors in the brain. Additional support came from Allergan, AstraZeneca, Bristol-Meyers Squibb, Cayman Chemical, Eli Lilly, Elsohly Laboratories, Merck, Pfizer, two Hungarian companies -Gedeon Richter Pharmaceutical and Sigma-Aldrich- and G.W. Pharmaceuticals. Researchers affiliated with other drug companies presented papers and posters and audited the proceedings. For most the holy grail is a product that will exert the beneficial effects of cannabis without that bad side-effect known as "euphoria."Complete Article:
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Comment #12 posted by FoM on July 08, 2006 at 21:25:36 PT
Dr. Tod
The first time I heard about Dr. Tod was back in 97 or 98. I really appreciate him for standing up for cannabis and many people. It is wrong the way they've treated him. I hope he is doing ok these days.
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Comment #11 posted by Hope on July 08, 2006 at 21:18:08 PT
Tod H. Mikuriya, MD
There can't be enough good said about this man. He is a "Hero". He's so brave. He's standing up against a very real "Evil Empire".His courage is wonderful to behold. They've tried to hurt him before. I fear what the government would like to do to him. I pray for him. I hope we'll stand up for this brave and righteous man if we have to. I'm afraid for him because of those wicked people who would, in their free will, harm him. 
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Comment #10 posted by ekim on July 08, 2006 at 18:12:33 PT
thank you from the bottom of our hearts Dr. Tod
Jury nullification
Somehow I missed this story.
A federal appeals court overturned the pot-growing convictions of Ed Rosenthal Wednesday because of a juror's phone call to an attorney friend, who told her to follow the judge's instructions or she could get in trouble."Jurors cannot fairly determine the outcome of a case if they believe they will face 'trouble' for a conclusion they reach as jurors," said the opinion by Judge Betty Fletcher. "The threat of punishment works a coercive influence on the jury's independence."Rosenthal's lawyer, Dennis Riordan, said "There would not have been a conviction but for this outside influence" of the attorney's advice, Riordan said. "Jurors never can be told they can get in trouble for what they say during deliberations."
Of course the reality is, as the article goes on to detail, jurors do get punished for exercising their right to jury nullification and they are threatened regularly for even suggesting the concept should be employed. In fact, anyone who expresses this knowledge during the selection process is unlikely to be seated and if they do manage to slip in and use that power, the consequences are costly. If you're not familiar with the concept, it's basically that as a juror you are not obligated to follow the judge's instructions. You do have to right not to convict, even if the law would require you to do so, because you can't in good conscience vote to uphold the law. But God help you if you decide to use it.It's a double edged sword, since jurors could also convict when the fine points of law would protect a defendant, but it seems a chance worth taking to restore the citizen's proper role in the justice process. If juries have been reduced to merely rubberstamping the judge's decision in criminal cases, then it seems pointless to bother us with jury duty. We should drop the charade and simply go to all bench trials. [hat tip Mad Maxx]
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Comment #9 posted by Wayne on July 08, 2006 at 16:19:28 PT
a different perspective
"There's scepticism, too, about the West's motives on the drugs issue, that its only real concern is reducing the supply of heroin to its own streets."--Really, whatever would give you that idea? You think the US is fighting the War on Drugs because they're concerned about everyone else's health and safety? The US government just doesn't want drugs on its streets. Period. It could give a s*** about the international community. (I think we've seen that already with that 'other' war)"It's not only because the farmers don't have alternatives," he says. "It's also because the Taleban and al-Qaeda are forcing them to grow poppy."--If we would stop fighting the War on Drugs, then opium's value would plummet, and then there wouldn't be any money to be had from them forcing you to grow poppy. I know, it makes me angry, too. Ending it sounds like a viable alternative to fighting them now, since our bank-account-tracking scheme has been blown out of the water.
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Comment #8 posted by sam adams on July 08, 2006 at 15:55:30 PT
JR, thanks for forwarding. An interesting situation has developed - the Afganis are producing opium that Western goverments don't want, and we're producing alcohol that the Afgani government doesn't want.Funny, I don't see them insisting that we stop producing alcohol. Or poisoning our fields of grains and hops.
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Comment #7 posted by JR Bob Dobbs on July 08, 2006 at 15:25:32 PT
"Losing The War On Afgan Drugs" - BBC
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Comment #6 posted by mayan on July 08, 2006 at 14:06:54 PT
Let Doctors Be Doctors!
Physicians and parents both face stigma and take risks in authorizing cannabis use by children, but the risks are legal and social rather than medical. The case of Alex P. exemplifies this reality.Pigs,politicians and judges need to quit acting like they're doctors. Let doctors be doctors!THE WAY OUT IS THE WAY IN...NORWAY STRIKES AGAIN! Of Largest 9/11 Families Group Says Government Complicit In Attack:'s Father Bill Doyle Dicusses 9/11 Coverup - MP3 Download (scroll down):’s ashes still hot; Barrett next to be burned at stake:, Extra! Vanity Fair Covers Loose Change! of 9/11 Exceeded Their Software Limits:
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Comment #5 posted by lombar on July 08, 2006 at 14:06:34 PT
Dilaudid ok, pot not. A sick society.
So they were banging this kid up with hydromorphone (dilaudid is the most powerful opiate) but sent him to rehab for pot? That is appalling! Awesome article though. Sedatives, barbituates, speed, and opiates, all given to a teenager with no positive result while he was punished for seeking what did help. 
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Comment #4 posted by Sam Adams on July 08, 2006 at 13:38:48 PT
Why do you think they put the whole "do not harm" thing in there - doctors have been harming people for millenia. It was a vain attempt to improve their ethics!I've had several friends become doctors, and only 1 was motivated by helping people. The rest were after lots of money, or merely the status of being a doctor. 
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Comment #3 posted by Wayne on July 08, 2006 at 13:23:47 PT
Someone should send THIS article to Karen Tandy and see what she has to say about it. Maybe it would give her a heart attack.
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Comment #2 posted by Wayne on July 08, 2006 at 13:22:12 PT
yeah, wow
This was a very uplifting article. One thing caught my eye:"The case of Alex P. suggests that employing pharmaceutical stimulants, antidepressants and anti-psychotics exposes children gratuitously to harmful side effects in violation of Hippocratic principles."Yeah, whatever happened to Hippocratic principles? Why does the FDA not adhere to Hippocratic principles? DO NO HARM?? I think that has all been lost in the minds of today's American public. Arresting people for having a plant in their pocket is HARMFUL. Approving prescription medicines that cause death in thousands of people is HARMFUL.What happened to doing what's best for the patient? What happened to "do no harm"? Why in God's name do we put the determination of people's health and well-being in the hands of the JUSTICE Department???
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Comment #1 posted by Sam Adams on July 08, 2006 at 12:03:14 PT
This article made me almost shed a tear out of love and respect for Dr. Mikuriya. What a hero. What a role model for anyone. Standing alone against his peers, possessing the courage to fight almost everyone in his profession, with the only goal of helping others.In the age of hype, lying, and greed, this guy has character and integrity in spades.  I only hope his efforts and others are enough to save us from ourselves.As for the standard practice of forcing drugs on people's children against their will and the prevailing medical and legal police state we live in, I'll try to forget those and focus on the heroism of this one man for today. Thank you Tod!
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