|Frank Lucido, MD *(Berkley) is
a family practitioner who began approving patients' use of cannabis soon
after the passage of Prop. 215. He conducts about 900 cannabis
consultations per year (including follow-up visits)
|1. Approvals issued: >3,000
2. Previously self-medicating: 99%
3. Conditions treated with cannabis:
|Chronic pain 75% Most diagnoses are musculoskeletal, i.e. dis disease,
post-traumatic injuries, etc. Others include Fibromyalgia Syndrome (2%),
Rheumatoid Arthritis, Psoriatic Arthritis, Systemic Lupus Erythematosis,
Lyme Arthritis, Raynaud's Syndrome, Gout, Gulf War Syndrome.
*Psychiatric problems (33%),
including Depression, Chronic Anxiety,
Insomnia, Bipolar, PTSD, ADHD, and OCD.
Neurologic problems (14%), including headache, Multiple Sclerosis, Restless
Leg Syndrome, Parkinson's, Neuropathic Pain, Tremor, Seizure Disorder.
*Genito-Urinary problems (5.6%),
including sever Dismenorrhea, Menopausal
Syndrome, Endometriosis, PMS, Interstitial Cystitis, Nephrolithiasis
including chronic abdominal pain, hepatitis C,
Irritable Bowel Syndrome, Crohn's Ulcerative Colitis, GERD, Anorexia,
Nausea, Diverticulitis pain.
*Others (11%), notably Glaucoma (3%),
Medication side effects (2.6%), Asthma
Cancer, lymphoma, leukemia, Meniere's/tinnitus.
|Effects of cannabis:
Patients are able to be more active (work, exercise, etc.); sleep, eating
and overall ability to function improved.g
Drug use reduced?
Chronic pain patients report reduced use of opioids, NSAIDs, muscle
relaxants, sleeping pills.
Psychiatric and insomnia patients reduce use of tranquilizers, SSRT
antidepressants, and sleeping pills.
Neurologic patients reduce use of opioids, muscle relaxants, NSAIDs, tiptans
and other migraine headache remedies.
Unusual conditions treated?
Gulf War Syndrome. Patients use cannabis to mitigate chronic neuropathic
pain form nerve damage, chronic nausea, and migraine, as well as PTSD from
his experiences in combat.
Comments re strains and dosage:
Patients vary tremendously in their dosage needs. In general, Sativa
strains seem to have a mildly stimulating effect and are best for daytime
use. Indica has a mildly sedative effect and is best for evening use. Both
are reportedly effective for chronic pain.
Reported adverse effects are rare, in part because the patients coming to a
medical cannabis consultation has already found cannabis to be of benefit.
I have had perhaps 10 patients in 10 years who had never tried cannabis or
who hadn't use it in many years and were uncertain if it would effectively
treat their current illness or symptoms.
Two patients have discontinued use in response to decreased productivity.
The overwhelming majority report that they are MORE productive when their
symptoms are controlled with cannabis.
|In a recent series of 393 consecutive patients, 195 were male, 108 female.
Their ages, plotted, would form a bell curve:
<18 2 30-39 60 60-69 24
18-20 4 40-49 80 70-79 1
21-29 42 50-59 89 80-89 1
Over the course of my practice I have approved cannabis use by about five
patients per year for attention deficit disorders. In recent years,
however, more patients report using cannabis to treat ADD and AD/HS, and I
am issuing more approvals. The present rate is approximately one patient
Cannabis as a substitute for alcohol?
I have had only three patients in 10 years whose primary diagnosis for
cannabis was alcoholism. Many recovering alcoholics are using cannabis for
chronic anxiety and/or depression, so to some extent they are substituting
it as a treatment for problems they previously self-treated with alcohol.
Because alcohol can damage the liver and cause destructive behavior,
cannabis use is rightly termed "harm reduction"
Marian Fry, MD (Cool)
Mollie Fry graduated from UC Irvine School of
Medicine in 1985 and began her career as a family practitioner. She stopped
practicing in 1989 to home school her children. After Prop 215 passed, Fry,
who is herself a breast cancer survivor, resumed seeing patients (employing
a physician's assistant to handle the initial interview). Her husband,
attorney Dale Schafer, established an adjoining practice to advise patients
of their rights.
Fry and Schafer have been charged with cultivation under federal law. She
continues to practive wile fighting the charges.
1. Approvals issued: 12,000
2. Previously self-medicating: 80%
3. Conditions being treated:
Chronic pain, 85%.
Includes all etiologies from systemic disease, i.e.,
Fibromyalgia, Lupus, Rheumatlid Arthritis, to physical injuries such as
fractures incurred in motor vehicle accidents, gunshot wounds, failed
surgeries, Post-Traumatic Arthritis, Osteoarthritis and work-related
Psychiatric disorders, 15%. Includes *PTSD*,
Insomnia, Panic disorder.
Other illnesses include AIDS and Cancer (2%-3%), Glaucoma (1%-2%).
Psoriasis and Eczema (1%-2%).
Patients report feeling better able to face whatever illness they are
The majority of my patients report a decrease in the use of conventional
pharmaceuticals. Approximately 90% of those using narcotics decrease their
usage, and about half discontinue them altogether. Patients report feeling
better able to face whatever illness they are dealing with. Many express
relief that their pain and anxieties are being treated through a God-given
plant. Cannabis enables them to feel a part of their own treatment and a
part of their own healing.
Health is a state of mind, body and spirit. By restoring their connection
to nature, cannabis helps patients on all three levels.
*Medications discontinued or reduced *include Oxycontin, Norco, Percoset,
Vicodin, Flexeril, Soma, Valium, SSRI antidepressants, and blood-pressure
medications Norvasc and Hydrochlorothiazide.
Approximately 1% of my patients report reduced reliance or discontinuation
of seizure medication by substituting Cannabis for Dilantin and remain
seizure free. Many of my Glaucoma patients no longer require their timoptic
drops and are able to maintain normal pressures with the use of Cannabis.
Many of my patients who have lost hope in conventional pharmaceutical
treatments report enhanced health, decreased pain, decreased depression and
an overall sense of well-being despite chronic illness.
Unusual conditions successfully treated with cannabis?
Eczema, Psoriasis, and dermatits or all types are being treated
successfully. Also, skin reactions associated with Agent Orange.
Although it is not a medical condition per se, parenting problems are
alleviated by the use of cannabis. Mothers and fathers report enhanced
flexibility and an ability to identify the child's needs as those of a
separate and unique individual. Parents are able to interpret the child's
behavior in an age-appropriate manner. Improved communication leads to
shared experience. The parent becomes present and the child benefits from
the increase positive attention.
Many patients report that cannabis stimulates their interest in art, music,
poetry, writing, and other creative endeavors. Insight is manifested by an
ability to recognize one's place in the universe. Patients say cannabis
makes them less self-centered and egocentric and more aware of the needs of
other people. It makes them aware of how their own behavior affects other
people and how they may be contributing to negative interaction.
can be useful adjunct in the marital-counseling process.
Comments re strains and dosage?
As a result of Prohibition, not enough information is available regarding
strains and I don't feel comfortable making a comment on this subject.
Regarding delivery methods, I feel strongly that edible cannabis is
underutilized. As noted in a previous communication (Spring 2006), oral
ingestion involves processing by the liver, which minimizes the differences
between strains. Oral ingestion is recommended for those seeking long term
relief from chronic physiological problems such as pain, glaucoma, diabetes,
lupus, rheumatoid arthritis, and multiple sclerosis.
Just as patients who smoke cannabis learn to inhale as needed to achieve and
maintain their desired effect, patients who use oral cannabis can employ an
analogous titration process. If a patient is using a vegetable-oil extract,
s/he calculates the amount needed top produce the desired effect without
over-sedation (the "loading dose").
By determining how long it takes for
the effect to come on and wear off, patients can schedule a subsequent"maintenance dose" to keep on an even keel.
The sedation that may be perceived as a negative side effect during waking
hours is precisely the effect that chronic pain patients and others require
for a good nit's sleep.
Orally ingested cannabinoids can exert their effects for close to eight
hours - adequate sleep for most patients- eliminating the need for a
maintenance dose in the middle of the night.
The efficacy of cannabis applied topically as an ointment or tincture is
similarly underrated. Dose is controlled by the individual monitoring the
effects on the skin lesions being treated. My patients have had great
success with using 1/4 cup of extracted cannabis oil in a hot bath for
overall distribution, followed by localized applications to severely
Cannabinoids and possibly other healing components of the
plant are absorbed directly through the skin; the anti-inflammatory
properties are outstanding, reducing recovery time from injuries and
promoting healing of lesions. Topical cannabis has also been used by my
lupus patients and rheumatoid arthritis patients to increase the function of
joints and decrease nodule formation. Many recipes are available both
vegetable-oil-based and rubbing-alcohol-based preparations.
The most significant negative reactions are due to fear of incarceration and
the results of abuse by officers unwilling to honor California law.
|My office does not compile this data, but I can generalize with some
assurance that my patients are about two-thirds male and more than half are
over 50 years old. They are predominately white, with the majority having
completed high school and beyond. Those patients who are not disabled do not
report problems getting and maintaining satisfactory employment. Most use
Cannabis in the evening for relaxing and for chronic stresses and pains
associated with the workday and are not under the influence during work
ADHD diagnoses are misleadingly low. There are many high-achieving
successful, adults who use cannabis for other problems but in fact meet the
criteria for an ADHD diagnosis. Most ADHD patients in my practice are
teenagers with parental consent to substitute Cannabis for more dangerous
and addicting drugs like Ritalin, Dexedrine, etc. These patients do much
better with Cannabis, show marked improvement in appetite and sleep, and are
more successful in school.
Substitute for alcohol?
More that half my patients express a preference for Cannabis over alcohol.
Those who have been alcoholics as evidenced by DUI and other court
proceedings find that substituting Cannabis for alcohol makes it much easier
to remain sober. Ample research demonstrates the excessive alcohol use
often results in domestic violence and motor vehicle accidents. This is not
the case with Cannabis use form my experience.
Philip A Denney, MD (Redding, Lake Forest, Carmichael),
spent most of his
career as a family practitioner before specializing in cannabis
consultations in 1999. Aware that patients from all over the state were
coming to see him in an office near Sacramento, Denney expanded his practice
in 2004, opening offices in Orange and Shasta counties (in partnership with
Robert Sullivan, MD, whose separate response is on page 8)).
Approvals issued: 18,900
Previously self-medicating: 95%
Conditions being treated:
Chronic pain 50% (trauma, surgical, neuropathic, etc.) Cannabis works
particularly well for neuropathic pain.
Gastrointestinal conditions 15% (nausea, vomiting, Crohn's disease,
hepatitis C, etc.).
Psychiatric conditions 15% (anxiety, depression, bipolar disorder, PTSD,
Neurologic disorders 10% (multiple sclerosis, plegias, phantom pain,
Others 10%. Most common among these are glaucoma, addiction, and sleep
Results reported:* Cannabis is nontoxic and therefore quite safe. Dosing
is easy, involving self-titration, and there is no "hangover" effect. We do
not see any dependence or abuse problems.
Cannabis allows significant decreased use or elimination of many
prescription medications, particularly narcotics. Patients usually report
decreases of 50% or better.
Rare conditions being treated?
Many, including anorexia and other eating disorders, and rare cancers such
as pheochromocytoma. I am particularly impressed with the usefulness of
cannabis in Tourette's Syndrome.
Comments re strains and dosage?
There are virtually no pure Sativa or Indica strains being used by
California patients because of long term crossbreeding. Nor can we subject
strains in use to chemical analysis to determine their components.
The Indica type is preferred by patients for pain, spasm, sleep, and
mania. Indicas are said to have a higher CBD-to-THC ratio than Sativas.
The Sativa type is reportedly better for appetite and to alleviate
gastrointestinal symptoms. It has mild stimulant effects, elevating mood
and increasing activity.
The Indica type is preferred by patients for pain, spas, sleep, and mania.
Indicas are said to have a higher CBD-to-THC ratio than Sativas.
Dosage varies widely. Approximately 80% of patients use one ounce per week
or less; 20% use more. Patients ingesting via edibles or teas tend to use
more. The highest use among my patients is three ounces per week.
Not kept. Average age approximately 40 years. 75% male, 25% female.
Approval for ADHD?
A relatively common diagnosis, particularly in younger males.
Cannabis as a substitute for alcohol?
Patients frequently report success in using cannabis to maintain sobriety.
It is also used by many as a substitute for opiates and stimulants.
Cannabis is an underused treatment for substance abuse.*
Overdose from edible cannabis -an unpleasant drowsiness lasting six to
eight hours- is rare and transient.*
| Adverse effects?
Virtually none reported by patients except contacts with the legal system.
Patients are able to stop using easily in order to pass drug tests or when
traveling. Overdose form edible cannabis - an unpleasant drowsiness lasting
6-8 hours- is rare and transient.