MEDICAL MARIJUANA… FACT VERSUS FICTION Thomas F. Jan, DO, FAOCPMR Subspecialty Certified– Pain Medicine Diplomate – American Board of Addiction Medicine MASSAPEQUA PAIN MANAGEMENT AND REHABILITATION ADMINISTRATIVE DIRECTOR-CHRONIC PAIN MANAGEMENT 4200 SUNRISE HIGHWAY MATHER HOSPITAL-NORTHWELL HEALTH MASSAPEQUA, NY 11758 PORT JEFFERSON, NY 516-541-1064 THE I LOVE ME SLIDE: THOMAS F. JAN, DO, FAOCPMR, FKIA • 20 years private practice, board certified in pain medicine and addiction medicine • Current Chair, American Osteopathic Pain Medicine Conjoint Exam Committee • Administrative Director for Chronic Pain Management, John T. Mather Hospital, Port Jefferson, NY • Core faculty, PM&R residency program, Mercy Medical Center, Catholic Health System • Leadership Council, Long Island Council on Alcoholism and Drug Dependence (LICADD) • Medical Director, LICADD Opioid Overdose Prevention Program • Member, Nassau County, NY, County Executive's task force on Heroin and Prescription drug abuse • Former Medical Director, Town of Babylon Drug and Alcohol Program Disclosures: Speaker Bureau, US WorldMeds, Lucemyra OBJECTIVES A brief history of marijuana and its medical uses throughout history How does one get certified to prescribe medical marijuana Discussion about the endocannabinoid system (ECS) What receptors are there and what are they purported to do How do the various options affect the body through the ECS What are the risks involved and some discussion about the science MEDICAL MARIJUANA FOR OPIATE ADDICTION “I prescribed the cannabis simply with a view to utilizing a well-known remedy for insomnia, but it did much more than procure sleep. I think it will be found that there need be no fear of peremptorily withdrawing the deleterious drug, if hemp is employed.” Edward Birch, MD, 1889, The Lancet 2018-STATE MARIJUANA LAWS http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx 2018-STATE MARIJUANA LAWS http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx 2018-STATE MARIJUANA LAWS http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx 2018-STATE MARIJUANA LAWS http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx 2018-STATE MARIJUANA LAWS http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx 2018-STATE MARIJUANA LAWS http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx 2018-STATE MARIJUANA LAWS http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx 2018-STATE MARIJUANA LAWS http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx 2018-STATE MARIJUANA LAWS http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx 2018-STATE MARIJUANA LAWS http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx 2018-STATE MARIJUANA LAWS http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx 2018-STATE MARIJUANA LAWS http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx 2018-STATE MARIJUANA LAWS http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx 2018-STATE MARIJUANA LAWS http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx 2018-STATE MARIJUANA LAWS http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx 2018 STATE MARIJUANA LAWS http://www.governing.com/gov-data/safety-justice/state-marijuana-laws-map-medical-recreational.html 2018 STATE MARIJUANA LAWS • Thirty states and the District of Columbia currently have laws broadly legalizing marijuana in some form. • Eight states and the District of Columbia have adopted the most expansive laws legalizing marijuana for recreational use. • Most recently, sales of recreational-use marijuana in California kicked off on Jan. 1 of this year • In Massachusetts, retail sales of cannabis were legalized as of July 1st • The Cannabis Control Commission, the new state agency tasked with overseeing the burgeoning industry, has started issue the licenses needed for retail pot shops to open in Massachusetts • On July 9th, US Attorney Andrew Lelling, the top federal prosecutor in Massachusetts, stated that the three areas for potential marijuana prosecutions will include "overproduction," "targeted sales to minors," and "organized crime and interstate transportation of drug proceeds." • Maine legalized recreational marijuana January 30th of this year http://www.governing.com/gov-data/safety-justice/state-marijuana-laws-map-medical-recreational.html 2018 STATE MARIJUANA LAWS (CONT’D) • The vast majority of states allow for limited use of medical marijuana under certain circumstances • Some medical marijuana laws are broader than others, with types of medical conditions that allow for treatment varying from state to state • Louisiana, West Virginia and a few other states allow only for cannabis-infused products, such as oils or pills • Louisiana is considered to have legalized marijuana butit cannot be used in a form that can be smoked -- only oils, topical applications and other types. • Other states have passed narrow laws allowing residents to possess cannabis only if they suffer from select rare medical illnesses. • A number of states have also decriminalized the possession of small amounts of marijuana. http://www.governing.com/gov-data/safety-justice/state-marijuana-laws-map-medical-recreational.html 2018 STATE MARIJUANA LAWS (CONT’D) Federal law, however, prohibits doctors from prescribing marijuana!!! http://www.governing.com/gov-data/safety-justice/state-marijuana-laws-map-medical-recreational.html THE NEW YORK STATE MEDICAL MARIJUANA PROGRAM On July 7, 2014, Governor Cuomo signed a medical marijuana bill into law. WHAT IS IT ALL ABOUT? Requirements to become a registered medical marijuana physician: Be licensed physician and practicing in New York State The NYS Health Commissioner has the option of including nurse practitioners based on patient need and access Be qualified to treat the serious condition for which medical marijuana is being recommended Have completed a 2-4 hour training course approved by the NYS Department of Health Have registered with the NYS DOH as a recommending physician. The NYS MMP overview; Compassionate Care New York | 347.781.5435 voice | [email protected] | www.compassionatecareny.org WHAT IS IT ALL ABOUT? How does the physician recommendation work? Rather than write a prescription, the physician will issue a recommendation or certification that an eligible patient can obtain and use medical marijuana. A certification is good for one year (or less if the physician specifies a shorter time frame) or, if the person is deemed to be terminally ill, until their death. Once a patient has obtained a physician certification, s/he applies to the DOH for a patient registry card, which allows him or her to legally purchase and use medical marijuana obtained from a state-licensed dispensary. The NYS MMP overview; Compassionate Care New York | 347.781.5435 voice | [email protected] | www.compassionatecareny.org WHAT IS IT ALL ABOUT? Qualifying conditions: Cancer Epilepsy HIV infection or AIDS Inflammatory bowel disease Amyotrophic lateral sclerosis (ALS) Neuropathy Parkinson's disease Huntington's disease Multiple sclerosis Post-traumatic stress disorder Spinal cord injury with spasticity Chronic pain The NYS MMP overview; Compassionate Care New York | 347.781.5435 voice | [email protected] | www.compassionatecareny.org WHAT IS IT ALL ABOUT? Must have one of the following clinically associated conditions, symptoms or complications: Cachexia or wasting syndrome severe or chronic pain resulting in substantial limitation of function severe nausea seizures severe or persistent muscle spasms such other conditions, symptoms or complications as added by the commissioner Title 10, Department of Health 10 NYCRR §1004.2(a)(9)(i-vi) WHAT IS IT ALL ABOUT? Chronic pain as defined by NYS: Any severe debilitating pain that the practitioner determines degrades health and functional capability where the patient has contraindications, has experienced intolerable side effects, or has experienced failure of one or more previously tried therapeutic options and where there is documented medical evidence of such pain having lasted three months or more beyond onset, or the practitioner reasonably anticipates such pain to last three months or more beyond onset Title 10, Department of Health 10 NYCRR §1004.2(a)(8)(xi) THE HISTORY 2900 BC - CHINESE EMPEROR FU HSI REFERENCES MARIJUANA AS A POPULAR MEDICINE "The Chinese Emperor Fu Hsi (ca. 2900 BC), whom the Chinese credit with bringing civilization to China, seems to have made reference to Ma, the Chinese word for Cannabis, noting that Cannabis was very popular medicine that possessed both yin and yang." Robert Deitch Hemp: American History Revisited: The Plant with a Divided History, 2003 Source: https://medicalmarijuana.procon.org/view.timeline.php?timelineID=000026 1450 BC - BOOK OF EXODUS REFERENCES HOLY ANOINTING OIL MADE FROM CANNABIS "Holy anointing oil, as described in the original Hebrew version of the recipe in Exodus (30:22-23), contained over six pounds of kaneh-bosem, a substance identified by respected etymologists, linguists, anthropologists, botanists and other researchers as cannabis, extracted into about six quarts of olive oil, along with a variety of other fragrant herbs. The ancient anointed ones were literally drenched in this potent mixture.“ Chris Bennett "Was Jesus a Stoner?," High Times Magazine, Feb. 10, 2003 "Marijuana proponents suggest that the recipe for the anointing oil passed from