AN INTERVIEW WITH JEFFREY HERGENRATHER, MD

What Have California Doctors Learned About Cannabis?

It has been 10 years since California voters enacted Proposition 215,
making it legal to grow and use cannabis, with a doctor's approval,
for medical purposes. Prop 215 didn't create a record-keeping system
because the authors didn't trust the government and didn't want to
generate a master list of cannabis users. So, over the course of the
past decade, a vast public health experiment has been conducted in
California but no state agency has been tracking doctors who approve
cannabis use or patients who medicate with it.

To assess the results in the absence of government-garnered data, I
surveyed doctors associated with the Society of Cannabis Clinicians.
The SCC was founded by Tod Mikuriya, MD, in 2000 so that doctors
monitoring their patients' use of cannabis could share data for
research purposes (and, alas, respond to threats from federal and
state authorities). More than 20 doctors have attended SCC meetings,
which are held quarterly. Philip A. Denney, MD, is the current president.

Some responses to the survey have not yet been received, but it
appears that the specialists have approved cannabis use by more than
140,000 patients. "Approve," not "recommend," is the apt term, since
more than 95 percent of the patients consulting specialists had been
self-medicating previously.

The specialists account for approximately 40% of the letters of
authorization on file with an agency that issues ID cards on behalf
of cannabis dispensaries (to spare them having to confirm the
validity of each customer's letter of approval). Extrapolating from
this ratio, I estimate the number of Californians who have used
and/or provided medicinal cannabis legally under Prop 215 to be about 350,000.

The complete survey will appear in the Fall issue of O'Shaughnessy's,
a journal I produce for the SCC. What follows are excerpts from the
response of Jeffrey Hergenrather, MD, a former family practitioner
who has been conducting cannabis consultations in Sebastopol since 1999.

Q. How many patients will have received your approval to use cannabis
through October 2006?

A. 1,430

Q. What percentage had been self-medicating with cannabis prior to
consulting you?

A. 99%

Q. With what medical conditions have they presented? List top five
and approximate percentage (total can exceed 100%).

Chronic pain (62%), Depression and other mental disorders (30%),
Intestinal disorders (12%), Harmful dependence (10%), Migraine (9%)
are the most common conditions being treated.

Q. What results do patients report? How does cannabis appear to work
in treating their symptoms?

A cannabis specialist soon becomes aware of two remarkable facts. The
range of conditions that patients are treating successfully with
cannabis is extremely wide; and patients get relief with the use of
cannabis that they cannot achieve with any other pharmaceuticals.

The testimonies that I hear on a daily basis from people with serious
medical conditions are moving and illuminating. From many people with
cancer and AIDS come reports that cannabis has saved their lives by
giving them an appetite, the ability to keep down their medications,
and mental ease. No other drug works like cannabis to reduce or
eliminate pain without significant adverse effects. It evidently
works on parts of the brain involving short-term memory and pain
centers, enabling the patient to stop dwelling on pain. Cannabis
helps with muscle relaxation, and it has an anti-inflammatory action.
Patients with rheumatoid arthritis stabilize with fewer and less
destructive flare-ups with the regular use of cannabis.

Other rheumatic diseases similarly show remissions. Spasticity cannot
be treated any more quickly or efficiently than with cannabis, and,
again, without significant adverse effects.

Patients who suffer from migraines can reduce or omit conventional
medications as their headaches become less frequent and less severe.

About half of the patients with mood disorders find that they are
adequately treated with cannabis alone while others reduce their need
for other pharmaceuticals. In my opinion, there is no better drug for
the treatment of anxiety disorders, brain trauma and post concussion
syndrome, ADD and ADHD, obsessive compulsive disorder, and
post-traumatic stress disorder. Patients with Crohn's disease and
ulcerative colitis are stabilized, usually with comfort and weight
gain, while most are able to avoid use of steroids and other potent
immunomodulator drugs.

People who were formerly dependent on alcohol, opiates, amphetamines
and other addictive drugs have had their lives changed when
substituting with cannabis. Patients with end-stage renal disease on
dialysis and those with transplanted kidneys show mental ease,
comfort, and lack of significant graft-versus-host incompatibility
reactions in my small series.

Diabetics report slightly lower and easier-to-control blood sugar
levels, yet to be studied and explained.

Sleep patterns are typically improved, with longer and deeper sleep
without any hangover or significant adverse effects.

Many patients with multiple sclerosis report that their condition has
not worsened for many years while they have been using cannabis
regularly. MS and other neurodegenerative diseases share the common
benefits of reduced pain and muscle spasms, improved appetite,
improved mood and fewer incontinence problems. Many patients with
epilepsy are adequately treated with or without the use of other
anticonvulsants.

Patients with skin conditions associated with systemic disease such
as psoriasis, lupus, dermatitis herpetiformis, and eczema all report
easement and less itching when using cannabis regularly.

Airway diseases such as asthma, sleep apnea, COPD, and chronic
sinusitis deserve special mention because I encourage the use of
cannabis vapor or ingested forms rather than smoking to reduce airway
irritation. Finally, most obese and morbidly obese patients respond
with weight loss and improved self esteem. I believe that cannabis
and psychotherapy work well together in fostering behavioral changes.

Q. Have you compiled demographic data or can you estimate the
breakdown with respect to your patients' age, gender, race, economic status?

Gender: 62% male, 38% female. Ages range from 14 to 86 years old. The
male mean age is 45.9 years with a median age of 46. The female mean
age is 47.4 with a median age of 48 years. The graphs of the age and
gender distribution are similar with the exception that there is a
bump in the leading edge of my male patient population as compared to
the females, which I account for by young men's work injuries, sports
injuries, motor vehicle accidents, and problems stemming from
military service, including injuries and post-traumatic stress
disorder. The vast majority of patients in my practice are of
Caucasian / Indo-European descent, with only about 1%
African-American, 2% Native American, 1% Pacific Islanders, and 2% Asian.

Q. Have you observed or had reports of adverse effects from cannabis?
If so, please describe.

Is there a downside to the use of cannabis? The sense of intoxication
rarely lasts longer than an hour and tends to be more troubling to
the novice than to the experienced user. For some people cannabis can
induce dry mouth, red eyes, unsteady gait, mild in-coordination, and
short-term memory loss, all of which are transient. These effects are
reportedly trivial compared to those brought on by pharmaceutical alternatives.

Cannabis use is steadily finding acceptance in society. Still, for
many it remains awkward if not totally impractical in the workplace.
People whose jobs require multi-tasking such as pilots, drivers,
dispatchers, switchboard operators, and many professionals find the
intoxicating effects of cannabis inappropriate in the workplace, and
therefore reserve their use for after work. Strains

Q. What have you learned re strains and dosage?

Cannabis is a complex, un-patentable plant with vast pharmacologic
potential. Different strains contain different mixes of cannabinoids
and terpenes that give them distinct qualities. Some strains energize
you; others put you to sleep. Many patients, when they find a strain
that suits their needs, try to obtain it on a regular basis. Unless
they are growing their own from cuttings, however, they have to rely
on growers and distributors to reproduce and make available the
preferred strain from year to year.

Due to Prohibition, California growers have been denied the tools of
analytical chemistry to test the cannabinoid contents of their
plants. This has impeded the development of strains aimed at treating
various conditions. Nevertheless, patients continue to educate
themselves about cannabis as medicine and how best to use it. Over
the years that I have specialized in cannabis therapeutics, health
benefits reported by patients have been substantiated and explained
by findings from research centers around the world.

Vaya Con Dios

The great Freddy Fender died last week -lung cancer at age 69. From
his Associated Press obit: "his career was put on hold [in 1960] when
he and his bass player ended up spending almost three years in prison
in Angola, LA., for marijuana possession." He was born Baldemar
Huerta and took the name Fender in honor of his electric guitar when
he signed with Imperial Records in 1959. He took "Freddy" because he
thought it sounded good with Fender. I never stopped giving my vinyl
"Best of Freddy Fender" a spin.

Look at how America treats its artists, its national treasures!
Clifford Antone, founder of Austin's famous blues club, died in May
of this year. He served two prison terms, according to his obit in
the New York Times, "one in the 1980's for possessing marijuana and
another from 2000 to 2002 for dealing more than 9,000 pounds of the
drug and laundering money Mr. Antone was known for his generosity to
musicians. He organized a series of benefits for victims of Hurricane
Katrina and recently he helped arrange an apartment and nursing care
for the 92-year-old pianist Pinetop Perkins."

Paul Armentano of NORML has analyzed a new U.S. Department of Justice
report for 2004 and concludes that U.S. taxpayers are now spending
more than a billion dollars annually to incarcerate citizens for pot.
Armentano estimates that 33,655 state inmates and 10,785 federal
inmates are locked up on marijuana charges. The DOJ report didn't
provide stats for county jails.

Thousands behind bars cannot see the stars

Shining o'er the land of the free

They could be at home if they could grow their own

Or get it from the local pharmacy.