Place title of presentation here. Key words can be highlighted in yellow.

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Marijuana Access, use and harm reduction.
Amanda Reiman, PhD MSW Policy Manager,
CA areiman_at_drugpolicy.org
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Todays Talk

• Part I Becoming a legal patient in CA.
• Part II A review of the medical evidence
• Part III Marijuana as a substitute for other
  drugs

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Part I

• Becoming a patient in CA

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Who Can Be a Patient in CA?

• Text of the law any condition for which
  marijuana provides relief
• Why is it so open?
• How does this compare to other states?
• Most common reasons for use in CA
• Chronic pain, insomnia, anxiety
• Physical AND mental health conditions

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The Process

• Obtain a recommendation from a licensed physician
• Difference between recommendation and
  prescription
• Do I need a card?
• Patient ID Center in Oakland
• SF Dept. of Public Health
• Should I get a growers certificate?
• Finding a dispensary
• Weedmaps.com
• Stickyguides.com
• IPhone apps

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The Pot Docs

• Why are all these clinics opening up?
• Are these REAL doctors?
• How do I know which to choose?
• Medi-Cann
• Dr. Lucido
• What will happen once I go there?
• Do they take insurance?

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Benefits and Risks of Being a Patient

• Benefits
• Legal protection
• Access to safe medicine
• Access to a variety of medicine
• Additional services at dispensaries
• Purchase risk vs. illicit market
• Risks
• Federal law does not recognize medical marijuana
• Public housing, employment, child issues
• CHP can be hit or miss

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FAQs

• Can my doctor report me for asking him/her to
  write a recommendation?
• Do I have to have a recommendation from the city
  where I will be obtaining marijuana?
• How does the caregiver program work?
• How much marijuana can I grow for myself?
• Can I bring medicine to other states?
• Can I purchase medicine in other medical
  marijuana states?
• Can an employer ask me if I am a medical
  marijuana patient?

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Suggestions for staying safe

• Put your medicine away as soon as you get back in
  the car
• Do not medicate in public
• Do not come to work, childs school, etc. heavily
  medicated if possible
• Do not talk about your patient status too openly
  with co-workers, other parents etc.
• If you live in Federal or shared housing, try
  vaporizers or edibles.

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Dos and Donts

• DO Keep a journal of the products and strains
  you use so you know what works best for you.
• DO Use marijuana for the first time with someone
  who has used it before if possible.
• DO Ask questions at the dispensary. Never feel
  embarrassed!
• DONT Drive or operate heavy machinery until you
  know how marijuana affects you.
• DONT Consume your medicine in a place where you
  are vulnerable (car, park, etc.)
• DO Enjoy it! DONT feel guilty for feeling
  good!!!!

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Part II

• Modern marijuana therapeutics

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Modern marijuana therapeutics...

• Used to be thought of for symptom management, but
  curative?
• Low toxicity makes it appealing
• 19 states plus DC allow medical marijuana use
• Endocannabinoid system may hold the key

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A review of the recent evidence Alzheimers
Disease

• 2 recent studies (2005 2007) found that the
  administration of a synthetic cannabinoid
• prevented cognitive impairment
• decreased neurotoxicity
• reduced the brain swelling associated with AD
• led to better performance on a maze memory test
• Neuro-protective qualities of marijuana

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Recent evidence Chronic Pain

• Most common reason for medical marijuana use.
• Clinical trials (2007 2008) have shown that
  smoked marijuana reduced the neuropathic pain of
  AIDS patients more than 30 compared to placebo.
• Key aspects
• Multifunctional Calming AND addresses nerve
  pain.
• Multiple cannabinoids work better than single
  ones (Entourage effect).
• marijuana opiates works better than opiates
  alone.

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Recent evidence Gliomas (brain tumors)

• Numerous studies report that cannabinoids play a
  role in cancer cell death. Furthermore, natural
  THC has been found to be more effective than
  synthetic THC.
• There is also support for cannabinoid based
  therapies for a slew of other cancers, including
  breast, prostate and skin cancer.
• Unlike chemotherapy, cannabinoids can
  differentiate between healthy and unhealthy
  cells.

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Recent Evidence Other conditions

• Lou Gehrigs disease
• MS
• Arthritis and osteoperosis
• Diabetes mellitus
• Fibromyalgia
• GI disorders (IBS, Krohns..)
• Hepatitis C
• HIV
• Hypertension
• Incontinence
• Tourettes syndrome
• MRSA
• Sleep Apnea
• ADD/ADHD/Autism

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marijuana and mental health

• Like all drugs, the safety of marijuana is
  affected by set and setting.
• There is support for the link between marijuana
  use and symptoms of depression, psychotic
  problems, and schizophrenia. These occurrences
  are largely among adolescents and those
  pre-disposed to mental illness
• Treating PTSD, anxiety and depression
• Different cannabinoids have different effects
• THC vs. CBD

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For more information...

• Armentano, P. (2010). Emerging Clinical
  Applications for Cannabis and Cannabinoids A
  review of the recent scientific literature,
  2000-2010. Available online at www.norml.org

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Part III

• marijuana and SUD, and as a substitute for
  alcohol, illicit and prescription drugs

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How it relates to SUD treatment

• Do people in SUD need to abstain from marijuana?
• Schwartz, 2010 This exploratory study suggests
  that medical marijuana is consistent with
  participation in other forms of drug treatment
  and may not adversely affect positive treatment
  outcomes. In this small sample, marijuana use did
  not seem to compromise substance abuse treatment
  amongst the medical marijuana using group, who
  (based on these preliminary data) fared equal to
  or better than non-medical marijuana users in
  several important outcome categories (e.g.,
  treatment completion, criminal justice
  involvement, medical concerns).
• What is the role of the SUD counselor regarding
  marijuana use?
• Response from traditional 12 step programs
• Role of marijuana in harm reduction

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Types of substitution

• Psychoactive
• Instead of wine after work
• To address and reduce cravings for other
  substances
• Treating addiction
• To improve outcomes while reducing side effects
• Prescription drugs

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Definition of terms

• Substitution
• Conscious/unconscious choice to use one drug
  instead of another
• First substitution study Mikuriya (1970)
• Relates to harm reduction
• safety
• level of addiction potential
• effectiveness in relieving symptoms
• access
• level of acceptance

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Medical marijuana patients and substitution

• Regular use, stable supply, access to not granted
  under a standardized prescription system, yet
  still legitimized by a doctors recommendation
  (self-medication)
• Mikuriya et al. (2007) survey of 11 medical
  marijuana doctors in California
• All doctors had seen patients who were using
  marijuana as a substitute for alcohol
• One said that over half of her patients reported
  preferring marijuana to alcohol
• Another reported that 90 of his patients reduced
  their alcohol use after beginning the use of
  medical marijuana

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Medical marijuana patients and substitution

• Reiman (2007) study of 130 medical marijuana
  patients
• 19 reported previous alcohol treatment
• 50 reported using marijuana as a substitute for
  alcohol
• 47 reported using marijuana as a substitute for
  illicit drugs
• 74 reported using marijuana as a substitute for
  prescription drugs

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Medical marijuana patients and substitution

• Harris et al. (2000) study of 100 medical
  marijuana patients (mostly HIV patients)
• 59 reported alcohol abuse and 16 reported
  alcohol dependence in their lifetime
• Based on urinalysis, 50 tested positive for a
  drug other than marijuana
• 83 had experienced a psychiatric disorder in
  their lifetime and 44 were currently dealing
  with a psychiatric disorder self medication?
  Psychological symptoms of illness?

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Berkeley Patients Group Study

• N350 anonymous patient surveys collected at
  Berkeley Patients Group in Berkeley, CA
• Male (68) single (54), White (66), mean age
  39, health insurance (including Medical) (74),
  work full time (41), have completed at least
  some college (81), make less than 40,000 a year
  (55)
• 71 report having a chronic medical condition,
  52 use marijuana for a pain related condition,
  75 use marijuana for a mental health issue, 64
  need ongoing treatment in addition to marijuana
• 85 report marijuana has less unwanted side
  effects than their other treatment, 88 report
  that marijuana makes their symptoms much better.

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Berkeley Patients Group Study

• 40 have used marijuana as a substitute for
  alcohol, 26 as a substitute for illicit drugs
  and 66 as a substitute for prescription drugs
• The most common reasons given for substituting
  were less adverse side effects (65), better
  symptom management (57), and less withdrawal
  potential (34) with marijuana

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Thank you!

• areiman_at_drugpolicy.org for more information ?