Military Veterans who served active duty in wars, have access to VA health care. Some VA centers came under recent Congressional scrutiny, when it was discovered that the real wait times for Vet medical access were not honest, and were actually longer than what had been publicly known. Significant wait times for medical treatment can impact health outcomes. While the diagnosis and treatment of PTSD has received a lot of recent publicity, adequate PTSD treatment is still not precise, nor applicable to everyone. Other medical issues, such as underlying mental illness, multiple medications/drug interactions add to the complexity of medical treatment, as well as large systems that can be slow and difficult to change.
This article is NOT intended to disparage the VA Medical system. The VA actually has demonstrated remarkable progress in acute care medical treatment, electronic medical. This article attempts to provide information for more open medical communication between patients and their medical providers.
In this regard, a 2015 review of clinical studies of cannabis validated high-quality clinical evidence, for treatment of pain. The study was published in JAMA (The Journal of the American Medical Association). JAMA is an AMA peer-reviewed medical journal. The JAMA article, by Dr. Kevin Hill, MD, per his byline, specializes in Public Health at Harvard. Dr. Hill reviewed clinical cannabis studies, and ranked them according to objective, controlled outcomes, AKA evidence. Chronic pain treatment had very high quality evidence, but other diseases, such as cancer did not have enough quality evidence to support cannabis treatment. Federal Prohibition essentially eliminated, and sometimes may have disregarded, scientific evidence regarding cannabis as a medical treatment, not only for pain, but for major neurological disorders, cancer, and other illnesses. One cannabinoid, CBD, may have strong medical promise, but it needs clinical study, not just anecdotal reports, to enlist medical support.
ACNA (American Cannabis Nurses Association), is reaching out to healthcare professionals via annual conferences, and is educating about the human EndoCannabinoid System (ECS): our bodies make it’s own cannabinoids! The ACNA has joined with cannabis clinicians to provide online education about the ECS, so practicing physicians and nurses could have real time access to facts. The information for clinicians could help to educate and remove one barrier to moving science forward. Universities have Federal Funding and have been prohibited from studying or teaching about cannabis, and the ECS (except to demonstrate harmful effects, deal with addictions, etc. via DEA). The DEA holds a unique and significant power with prescribing medical professionals: their DEA license to prescribe controlled substances.
Including cannabis as a Schedule 1 drug (like heroin – according to The Controlled Substance Act of 1976), was likely an easy tool in the past to increase drug abuse stats and justify DEA funding, due to “drug” offenders, no matter the substance or level. Prohibition has impacted lives by creating criminals and cartels, and medical treatment costs continue to skyrocket, now forcing very tough government funding decisions being addressed by cutting the most vulnerable funds from Vets, elderly, disabled, poor – social programs that should help, but have been underfunded, until it is a crisis. No wonder Vets can’t get the help they need! The social care and healthcare system’s broken and needs active citizen involvement and journalist advocates, to help to focus on more sustainable short and long term fixes and not hype.
ACNA is proposing clinical studies of cannabis, to demonstrate that lower medical costs for pain treatment that could be demonstrated in an acute care setting, in states where medical cannabis is legal. A study project could take less than a year, from initiation to reporting. So far, there seems to be a lack of public health interest. However, in Colorado, one of the first two “legal” (AKA “recreational”) cannabis states, Colorado provided a very progressive method of funding some of their own research in 2014: taxes from sales of Legal (AKA “tecreational”) sales were used to fund research, approx. $9 mil.
Washington State has struggled without a good medical program, and recently a story quietly emerged that the head of the Liquor Control Agency resigned, due to stress (possibly from reportedly undermining the demise of medical dispensaries?). I have visited Washington a few times this year, spoken with medical dispensaries about feeling left out of the process and their fear of not being able to participate in the cannabis industry would drive them out of business. I recently observed several closed medical establishments. Time will tell if the story about possible collusion is accurate, but Washington medical patient access, may not survive. There are some new reports at attempts to recover medical use of cannabis, but stay tuned to see what happens.
Oregon learned from Washington’s mistakes and Colorado’s, as well as successes. Oregon is on a fast-track to develop high quality rules, from collaborating with the Industry, Citizens and being transparent with rule-making for the new Legal cannabis supply chain and retail, under the Liquor Control Commission (OLCC). It takes time to deliberate, but the outcome will be a better baseline for more accurate information about cannabis, including standardized lab testing , product labels, education and research opportunities.
The existing Oregon Medical Marijuana Program (OMMP), under the Oregon Health Authority (OHA) agency, has been a good program to help those patients in need, especially helping them afford cannabis, but OMMP may be at risk of losing affordable medical patient access to empathetic growers, as the recreational “Green Rush” takes over and limits the amount that small, high quality, patient-specific and clean farms can grow. It takes a lot more of the plant to produce concentrate for medical needs, versus flower alone.
Dedicated medical growers are actively focusing on a win-win going forward, to try and preserve the collected wisdom and compassion of the collective patient growing experience. Oregon has a great history of quality agriculture, and with the Dept. of Agriculture working together to align regulations with the Health Authority and Liquor Commission, there are significant expectations for quality Oregon cannabis rules by next year. Temporary rules are being finalized now and by next year, data should help provide important feedback.
To summarize:
• ACNA has clinical education available on-line about the ECS.
• High quality clinical evidence supports treatment of pain with cannabis.
• Hospitals should consider collaborating with ACNA on a pilot study to demonstrate health care cost savings, in states where it is legal for patients to use cannabis.
• More Medical education and Clinical studies are needed to demonstrate the value of proper Cannabis use, methods, dosing to treat pain, versus potentially dangerous, addicting and harmful substances, such
as opiods.
• Communicate with your Legislators about the facts: Cannabis is a medical herb that JAMA has published high quality evidence supporting pain treatment. Consider it as an alternative to Opiods and other proven dangerous narcotics for chronic pain.
• For novices, when used responsibly and with proper education, cannabis could be used safely for relaxation, AKA recreation, instead of trial and error.
MIKE ROCHLIN, RN, MN, COHN-S, CSP
American Cannabis Nurses Association