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American Society of Addiction Medicine

Public Policy Statement on Medical Marijuana

Background

In the last twenty years, both the scientific community and the public have become interested in the therapeutic potential of cannabis and cannabinoids. Scientific interest has been based in large part on the discovery and elucidation of the endocannabinoid receptor system. Popular interest has focused on state initiatives and other legislation decriminalizing the use of smoked cannabis for personal medical use.  Because of this legislation, herbal cannabis in various forms is now being distributed by dispensaries to large numbers of individuals with a wide variety of medical conditions. This cannabis is not, in most cases, standardized or quality-controlled; the dosage forms (smoked, vaporized, baked goods, teas, elixirs, etc.) do not provide a known and reproducible dose; and data on efficacy and adverse events are not being collected in a reliable manner. 

Cannabinoids are insoluble in water and subject to degradation by temperature and light; thus, optimal delivery systems or dosage forms are difficult to design. As a result, research into their medical applications is technologically challenging and has lagged behind that of the opioids and other modern medications. With improvements in technology and the development of research tools, such as high affinity agonists and antagonists, preclinical research has flourished.  At present, however, only a few properly controlled clinical studies, of adequate size and duration, have investigated the use of cannabis or cannabinoid products in specific therapeutic contexts.

The pace of such clinical research is increasing.  As corporate sponsors successfully resolve the regulatory and technological challenges, new products will enter the market. These products will be accompanied by extensive quality, pharmacological, toxicity, safety/tolerability, and efficacy data that will allow physicians knowledgeably to prescribe them, thereby making them available to appropriate patients. Risk Evaluation and Mitigation Strategies (REMS) will reduce the likelihood of abuse and diversion by both patients and non-patients, including adolescents.

The FDA approval process ensures that a robust body of data accompanies a product when it becomes available to patients. The FDA has invited industry to develop botanically based products and has set forth the regulatory path that must be followed to ensure that such products meet the standards of modern medicine.   It is feasible for cannabis-derived products to proceed down that path. Doing so will enable them to be recognized by the medical community as legitimate treatment options.

Under the current state distribution systems, physicians serve as the gatekeepers of patients’ access to cannabis, yet they lack both information on the quality/composition of the cannabis materials and data on their efficacy/safety. When specific cannabis-derived or cannabinoid medications have passed through conventional regulatory approval processes, and their risk/benefit profile in a particular medical condition is known, physicians can be confident that they are meeting the standard of care when advising patients about potential treatment choices.

“Cognitive dissonance” is a term that aptly describes the current approach to “medical marijuana.”  Scientists recognize the public health harms of tobacco smoking and urge our young people to refrain from the practice, yet most cannabis consumers use smoking as their preferred delivery mechanism. The practice of medicine is increasingly evidence-based, yet some physicians are willing to consider “recommending” cannabis to their patients, despite the fact that they lack even the most rudimentary information about the material (composition, quality, and dose, and no controlled studies provide information on its benefit and safety of its use in chronic medical conditions). Pharmaceutical companies are responsible for the harms caused by contaminated or otherwise dangerous products and tobacco companies can be held accountable for harms caused by cigarettes, yet, dispensaries distribute cannabis products about which very little are known, including their source. Efforts are being made to stem the epidemic of prescription drug abuse, including FDA-mandated risk management plans required for prescription medications, yet cannabis distribution sites proliferate in many states, virtually without regulation. 

In order to think clearly about “medical marijuana,” one must distinguish first between 1) the therapeutic potentials of specific chemicals found in marijuana that are delivered in controlled doses by nontoxic delivery systems, and 2) smoked marijuana.

Second, one must consider the drug approval process in the context of public health, not just for medical marijuana but also for all medicines and especially for controlled substances. Controlled substances are drugs that have recognized abuse potential.  Marijuana is high on that list because it is widely abused and a major cause of drug dependence in the United States and around the world.  When physicians recommend use of scheduled substances, they must exercise great care.  The current pattern of “medical marijuana” use in the United States is far from that standard. 

If any components of marijuana are ever shown to be beneficial to treat any illness then those components can and should be delivered by nontoxic routes of administration in controlled doses just all other medicines are in the U.S. 

In order for physicians to fulfill their professional obligations to patients, and in order for patients to be offered the high standard of medical care that we have come to expect in the United States, cannabis-based products must meet the same exacting standards that we apply to other prescription medicines.  Members of the American Society of Addiction Medicine (ASAM) are physicians first and experts in addiction medicine with knowledge specific to the risks associated with the use of substances with high abuse potential.  ASAM must stand strongly behind the standard that any clinical use of a controlled substance must meet high standards to protect the patient and the public; the approval of “medical marijuana” does not meet this standard.

Recommendations

1. ASAM asserts that cannabis, cannabis-based products, and cannabis delivery devices should be subject to the same standards that are applicable to other prescription medications and medical devices and that these products should not be distributed or otherwise provided to patients unless and until such products or devices have received marketing approval from the Food and Drug Administration.

2. ASAM rejects smoking as a means of drug delivery since it is not safe.

3. ASAM recognizes the supremacy of federal regulatory standards for drug approval and distribution.  ASAM recognizes that states can enact limitations that are more restrictive but rejects the concept that states could enact more permissive regulatory standards.  ASAM discourages state interference in the federal medication approval process. 

4. ASAM rejects a process whereby State and local ballot initiatives approve medicines because these initiatives are being decided by individuals not qualified to make such decisions (based upon a careful science-based review of safety and efficacy, standardization and formulation for dosing, or provide a means for a regulated, closed system of distribution for marijuana which is a CNS drug with abuse potential). 

5. ASAM recommends its members and other physician organizations and their members reject responsibility for providing access to cannabis and cannabis-based products until such time that these materials receive marketing approval from the Food and Drug Administration.

6. ASAM asserts that physician organizations operating in states where physicians are placed in the gate-keeping role have an obligation to help licensing authorities assure that physicians who choose to discuss the medical use of cannabis and cannabis-based products with patients:
• Adhere to the established professional tenets of proper patient care, including
o History and good faith examination of the patient;
o Development of a treatment plan with objectives;
o Provision of informed consent, including discussion of side effects;
o Periodic review of the treatment’s efficacy;
o Consultation, as necessary; and
o Proper record keeping that supports the decision to recommend the use of cannabis
• Have a bona fide physician-patient relationship with the patient, i.e., should have a pre-existing and ongoing relationship with the patient as a treating physician;

• Ensure that the issuance of “recommendations” is not a disproportionately large (or even exclusive) aspect of their practice;

• Not issue a recommendation unless the physician has adequate information regarding the composition and dose of the cannabis product;

• Have adequate training in identifying substance abuse and addiction .

 

 

 

Everyone is in denial about something; just try denying it and watch friends make a list.

Varieties of denial include inattention, passive acknowledgment, reframing and willful blindness.

For Sigmund Freud, denial was a defense against external realities that threaten the ego, and many psychologists today would argue that it can be a protective defense in the face of unbearable news, like a cancer or addictive diagnosis.

D - Don’t

E - Even

N – Notice

I – I

A – Am

L – Lying

In the modern vernacular, to say someone is “in denial” is to deliver a savage combination punch: one shot to the belly for the cheating or drinking or bad behavior, and another slap to the head for the cowardly self-deception of pretending it’s not a problem.

Yet recent studies from fields as diverse as psychology and anthropology suggest that the ability to look the other way, while potentially destructive, is also critically important to forming and nourishing close relationships.

The psychological tricks that people use to ignore a festering problem in their own households are the same ones that they need to live with everyday human dishonesty and betrayal, their own and others’.

And it is these highly evolved abilities, research suggests, that provide the foundation for that most disarming of all human invitations, forgiveness.

• via recoveryissexy.com

 

LISBON, Portugal – These days, Casal Ventoso is an ordinary blue-collar community — mothers push baby strollers, men smoke outside cafes, buses chug up and down the cobbled main street. Ten years ago, the Lisbon neighborhood was a hellhole, a "drug supermarket" where some 5,000 users lined up every day to buy heroin and sneak into a hillside honeycomb of derelict housing to shoot up. In dark, stinking corners, addicts — some with maggots squirming under track marks — staggered between the occasional corpse, scavenging used, bloody needles. At that time, Portugal, like the junkies of Casal Ventoso, had hit rock bottom: An estimated 100,000 people — an astonishing 1 percent of its population — were addicted to illegal drugs. So, like anyone with little to lose, the Portuguese took a risky leap: They decriminalized the use of all drugs in a groundbreaking law in 2000. Read more: http://www.foxnews.com/world/2010/12/26/portugals-drug-policy-pays-eyes-lesso...

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Overview of Marijuana Anonymous

Marijuana Anonymous is a fellowship of men and women who share our experience, strength, and hope with each other that we may solve our common problem and help others to recover from marijuana addiction.

The only requirement for membership is a desire to stop using marijuana. There are no dues or fees for membership. We are self-supporting through our own contributions. MA is not affiliated with any religious or secular institution or organization and has no opinion on any outside controversies or causes. Our primary purpose is to stay free of marijuana and to help the marijuana addict who still suffers achieve the same freedom. We can do this by practicing our suggested twelve steps of recovery and by being guided as a group by our twelve traditions.

Marijuana Anonymous uses the basic 12 Steps of Recovery founded by Alcoholics Anonymous, because it has been proven that the 12 Step Recovery program works!

The Twelve Steps of Marijuana Anonymous

The practice of rigorous honesty, of opening our hearts and minds, and the willingness to go to any lengths to have a spiritual awakening are essential to our recovery.

Our old ideas and ways of life no longer work for us. Our suffering shows us that we need to let go absolutely. We surrender ourselves to a Power greater than ourselves.

Here are the steps we take which are suggested for recovery:

1. We admitted we were powerless over marijuana, that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God, as we understood God.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked God to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory and when we were wrong, promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God, as we understood God, praying only for knowledge of God’s will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to marijuana addicts and to practice these principles in all our affairs.

Do not be discouraged; none of us are saints. Our program is not easy, but it is simple. We strive for progress, not perfection. Our experiences, before and after we entered recovery, teach us three important ideas:

1. That we are marijuana addicts and cannot manage our own lives;
2. That probably no human power can relieve our addiction; and
3. That our Higher Power can and will if sought.

• See also
• Marijuana Anonymous
• Addiction & Recovery Books
• Mindfulness for Recovery
• What is Relapse?
• Chicken Soup for the Recovering Soul

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As Women Age Their Libido, Fantasies, Sexual Experimentation and Activity Increases

As more women wait until their 30s and 40s to have children, they are more willing to engage in a variety of sexual activities to capitalize on their remaining childbearing years, according to new research by psychologists at The University of Texas at Austin.

Such "reproduction expediting" includes one-night stands and adventurous bedroom behavior, the research shows.

In a paper published in the July 2010 edition of Personality and Individual Differences, psychology researchers found that women age 27-45 have a heightened sex drive in response to their dwindling fertility.

In the study the researchers split 827 women into three groups: high fertility (ages18-26), low fertility (ages 27-45), and menopausal (ages 46 and up). The women answered an online questionnaire about their sexual attitudes and behavior.

Compared with the other groups, women with low fertility were more likely to experience:

• Frequent sexual fantasies
• Thoughts about sexual activities
• More intense sexual fantasies than their younger counterparts
• A more active sex life and willingness to have a one-night stand
• A willingness to have casual sex

 

Does Prayer Decrease Alcohol Consumption?

Four research studies involving 1,758 people show that prayer frequency cuts alcohol consumption.

In Study 1 of 824 people, we used a cross-sectional design and found that higher prayer frequency was related to lower alcohol consumption and problematic drinking behavior.

Study 2 of 702 people used a longitudinal design and found that more frequent prayer predicted less alcohol consumption and problematic drinking behavior at a later date, and this relationship held when controlling for baseline levels of drinking and prayer.

In Study 3 of 117 people, we used an experimental design to test for a causal relationship between prayer frequency and alcohol consumption. Participants assigned to pray every day (either an undirected prayer or a prayer for a relationship partner) for 4 weeks drank about half as much alcohol at the conclusion of the study.

Study 4 of 115 people replicated the findings of Study 3, as prayer again reduced drinking by about half.

Research; Nathaniel M. Lambert, Frank D. Fincham, Loren D. Marks and Tyler F. Stillman; Psychology of Addictive Behaviors; Volume 24, Issue 2, June 2010, Pages 209-219; Invocations and Intoxication: Does Prayer Decrease Alcohol Consumption?

• Not God – A History of AA
• Twelve Step Christianity – A Recovery Book
• Sought Through Prayer and Meditation – A Recovery Book

Prayer Steps to Serenity The Twelve Steps Journey: New Serenity Prayer Edition by L. G. Parkhurst Jr.

 

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King Heroin is my shepherd, I shall always want.

He maketh me to lie down in the gutters.

 

Self-forgiving is:

• Accepting yourself as a human who has faults and makes mistakes.
• Letting go of self anger for your past failures, errors, and mistakes.
• No longer needing penance, sorrow, and regret over a grievous, self-inflicted, personal offense.

More @ Recovery Is Sexy

To let go does not mean to stop caring, it means I can’t do it for someone else.

To let go is not to enable but to allow learning from natural consequences.

To let go is to admit powerlessness, which means the outcome is not in my hands.