PAIN SPECIALISTS MEET IN RENO

Some 49,000 motorcycle riders assembled in Reno last week-end for the
annual "Street Vibrations" get-together. Also in town were 900 doctors,
nurses and other members of the American Academy of Pain Management, whose
four-day meeting at the Hilton included talks devoted to cannabinoid
research. The AAPM's "cannabinoid track" was funded by GW Pharmaceuticals,
the British firm that is developing cannabis-based medicines under license
from the Home Office.

Ethan Russo, MD, a migraine specialist at the University of Montana,
provided an introduction to the field. He explained that components of the
cannabis plant other than THC exert effects of their own, and modulate the
effects of THC. He described cannabidiol CBD, which has been bred out of
the cannabis grown for psychoactive effect, i.e., all the sativas and
indicas grown in California as "a key but neglected component of cannabis
therapeutics." CBD, according to Russo, is "anxiolitic (anti-anxiety),
analgesic, anti-psychotic, anti-inflammatory and anti-oxidant in its own
right. Also, a very effective anti-spasmodic."

In addition to the cannabinoids, the cannabis plant contains hundreds of
compounds that are not unique to it amino acids, proteins, sugars,
hydrocarbons, simple esters, steroids, nitrogenous compounds, pigments,
vitamins, and more. According to Russo and John McPartland (whose
introductory talk was on the molecular level), terpenes and flavonoids in
cannabis definitely contribute to its medicinal effects. Terpenes are the
essential oils that give cannabis its smell (cannabinoids are odorless);
they are produced in the glandular trichomes. Russo says that certain
terpenes may have anti-ulcer and anti-mutagenic potential. (Something has
to explain the low incidence of lung cancer among marijuana-only
smokers.) A terpene called limonene "is a strong anti-depressant, we know
for sure," said Russo, citing a study in Japan of hospitalized patients
whose gloom was lifted by limonene wafted into the air. A terpene called
pinene is a broncho-dilator, which is helpful in asthma. (And now we know
why some weed is lemony and some is more piney.)

"Flavonoids are something that keep you healthy, keep you young, and keep
you from getting cancer," said Russo, "and there are quite a few in
cannabis." He singled out apigenin as an anti-anxiety agent and
anti-inflammatory, and quercetin, as an anti-oxidant. "Synergistic effect
of the components is the essence of herbal medicine," Russo observed. "In
some cases, plants may be better drugs than the products isolated from
them." And this is the essence of GW Pharmaceuticals' strategy: grow
plants with desired cannabinoid ratios and blend them "trace" components
and all into extracts that can be administered in defined doses by
spraying under the tongue.

Russo briefly pointed out the drawbacks of Marinol pure, synthetic THC,
which is taken in pill form. "The onset is very slow 60 to 120 minutes and
there is a loss of titration capability." Many patients feel nothing for a
long time and then suddenly feel zonked out, unable to function.
Ninety-five percent of THC is converted as it passes through the liver into
11-hydroxy-THC, a compound that Russo and others think induces dysphoria.
Russo says he has never had a patient who, given a choice between Marinol
and marijuana, prefers the former.

Cost may be a factor the pills can cost $10 each.

Only one of the 30-40 pain docs in attendance prescribed Marinol, according
to a show of hands.

Molly Fry, MD, and David Bearman, MD, raised their hands, too, but they
were ringers (California doctors long acquainted with the medical potential
of cannabis).

David Hadorn, MD, was slated to discuss GW Pharmaceutical trial-design
strategy, but donned another hat his own to critique the prevailing "gold
standard" by which medicines are evaluated:.the randomized clinical
trial Hadorn, whose interest in the politics of health care led him to get
a PhD in philosophy, has just moved to the Bay Area to observe from within
the medical marijuana movement in California. The approach to research that
he favors, systematic data collection and documentation, is based on common
sense: collect all the info on patients you can, including which treatments
produce which effects, put it in a large depository, and follow up over the
years. "What does randomization really buy you in the way of enhanced
validity?" Hadorn asks. "Why do the statisticians say, 'We don't really
know if it works until we do an RCT?' What is it about that randomness
thing? All it means is that you decide you're going to give this treatment
or that treatment maybe placebo or something else based almost on a flip of
the coin. And it's supposed to link somehow to that 'engine of chance' that
operates out there in nature, and thereby guarantee the validity of the
observations."

GW Pharmaceuticals launched its research effort in the UK in 1998 by taking
extensive surveys to determine who was using cannabis for what conditions
and with what results. They then chose to test their cannabis-based
medicines on patients with conditions Hadorn described as "slam dunk
indications" multiple sclerosis and chronic, intractable pain. "Cannabis is
well known not by randomized clinical trial, but who cares? to be
unsurpassed as a treatment for spasticity of whatever neurological cause,"
said Hadorn, heretically.

And sure enough, Hadorn was followed by William Notcutt, MD, who announced
promising results from a study conducted at James Paget Hospital in Great
Yarmouth, England, involving 34 patients with multiple sclerosis, spinal
cord injury, and other severely painful conditions that could not be
treated adequately with available drugs.

Patients received cannabis-plant extracts made by GW one rich in THC, one
rich in CBD, and an equal THC:CBD mix - along with placebo, at two week
intervals. Both the THC-rich extract and the THC:CBD mix reportedly
reduced pain and improved the quality and amount of sleep patients were
able to get. (Sleep deprivation is a significant aspect of chronic pain.)
The THC:CBD mix had the fewest adverse side effects (dry mouth being the
most common). Of the 34 subjects, 28 said they were helped and elected to
enter a longterm trial.

An overview of cannabinoid research in Canada was provided Mark Ware, MD,
of McGill University, who has the funding and approvals needed to conduct a
pilot study of smoked cannabis for chronic neuropathic pain. His group
awaits the arrival of the cannabis, which is to be provided by the U.S.
National Institute on Drug Abuse (NIDA).

J. Hampton Atkinson, MD, a co-director of the Center for Medicinal Cannabis
Research at UC San Diego, described its operation and the studies it has
funded to date. The CMCR was established and is funded through the state
legislature a bill authored by State Sen. John Vasconcellos. A companion
bill, so-called "enabling legislation" to implement Prop 215, has been
effectively vetoed by law enforcement lobbyists.

Given their "more research is needed" line, the drug warriors had to let
the research bill go through.

The AAPM's cannabinoid track included a brief talk by Valerie Corral of
Santa Cruz, who explained how the Wo/Man's Alliance for Medical Marijuana
works. Her account of how cannabis has restored an uncontrollably violent
eight-year-old to sociability was visibly moving to a group of nurses in
attendance. Valerie described the simple form that WAMM uses to assess the
effects of different plant strains on patients with various conditions. Of
all the cannabis providers that have been operating in California since
Prop 215 passed in '96, WAMM has been most conscientious in keeping such
records and trying to transform patients' anecdotal evidence into
meaningful epidemiological evidence.

Valerie mentioned but didn't dwell on the recent raid by the DEA on the
WAMM garden.

On Saturday night, as all but a few of the cannabis specialists departed
(and most of the pain docs partied), an extraordinary panel discussion took
place. Doctors Frank Fisher and Joe Talley (general practitioners from
California, and North Carolina, respectively), and Joel Hochman and Robert
Weitzel (psychiatrists from Texas and Nevada), described the criminal
charges and other nightmares they're facing as a result of prescriptions
they'd written for opiates.

One front of the war on drugs has always been the war on doctors.

After the Harrison Act was passed in 1914, thousands of doctors were
arrested for treating cocaine and opiate addiction as they had been for
years with maintenance doses of the prohibited drugs.

Today, according to Fisher, about 70 American doctors are in serious legal
trouble for prescribing painkillers as per their patients' needs.

We intend to report the terrible details in full, starting next week. The
medical marijuana issue, as Dennis Peron used to say, isn't just about
marijuana.

Thanks to Garry Trudeau

Doonesbury returned to the subject of medical marijuana this week. Zonker
is in Malibu with his old surfer pals demanding access to the beach that
David Geffen has privatized. He encounters Cornell (Mark's conservative
boyfriend), who says, "Remember my bust for growing medical pot? Well,
guess what - I lost the case. I'm going to prison." Expect a week's worth
of strips about the DEA's attacks on California patients and caregivers.

Exactly six years ago author Garry Trudeau played a key role in the passage
of Prop 215. In the late summer of '96, with management of the campaign
having been usurped from Dennis Peron by a Soros-funded "political
consultant," the margin of voter support, which had been almost 3-to-2
since polling began in the summer of '95, began to slip. Then Peron's
lieutenant John Entwistle heard from a friend Back East that Trudeau had
expressed interest in the recent bust of their Cannabis Buyers Club.
Entwistle sent Trudeau a packet of news stories describing the bust. On
Monday, Sept. 30 newspapers nationwide began running a Doonesbury strip in
which Cornell tells Zonker, "I can't get hold of any pot for our AIDS
patients. Our regular sources have been spooked ever since the Cannabis
Buyers' Club in San Francisco got raided..."

Attorney General Dan Lungren, the de facto leader of the No-on-215
campaign, urged the publishers running Doonesbury to spike that week's
strips. "Alternatively," he suggested, "your organization should consider
running a disclaimer side-by-side with the strips which states the known
facts related to the Cannabis Buyers Club." Lungren called a press
conference for Tuesday, Oct. 1, to reveal the evidence his Bureau of
Narcotics Enforcement had assembled against Peron. But the AG lost his
cool during the question-and-answer session. "Skin flushed and voice
raised, Attorney General Dan Lungren went head-to-head with a comic strip
Tuesday..." is how Robert Salladay began his Oakland Tribune story. Don
Asmussen in the SF Examiner lampooned "Lungren's War on Comics." The New
York Times devoted two full columns to the brouhaha, including a quote from
Peron: "Crybaby Lungren... I think he's just gone off the deep end.
Waaa!" The decline in the polls was reversed and Prop 215 went on to win
by 56 to 44 percent.

Two years later Lungren lost his bid for the governorship to Gray Davis by
a 61-39 margin.

He's working in Washington, D.C. now as a lobbyist.

In our deceitful mass media, the cartoonists seem to have the greatest
leeway in portraying social reality.

On TV, for example, the writers of King of the Hill can tell it like it is.
Trudeau gets away with it in print. And Matt Groening, of course, in both
formats.

P.S. On Barney Frank

As reported last week, Rep. Barney Frank is still blaming Ralph Nader for
costing Al Gore the presidency. "Anybody who can't tell the difference
between Tom Delay and Nancy Pelosi has been on another planet," said Frank
at an Oakland fundraiser, just in case anybody was still thinking Green
Party in 2002. Well, Barney, here's the difference: Tom Delay says "I'm
an exterminator and I'd just as soon exterminate you. I have a bullwhip and
I'd love to crack it on your ass." Nancy Pelosi says, "I'm a sophisticated
lady so it's all right for me to give the Presidio to my rich realtor
friends. They go to the symphony, too." And when the realtors tear down
Wherry Housing decent apartments well maintained by generations of enlisted
personnel in a city where thousands are homeless, it will be Nancy Pelosi's
doing. The implicit fatalities aside, the transfer of our decommissioned
military bases to the private sector is theft on a scale so grand it can
only be compared to the giveaway of public lands to the railroad owners in
the mid-19th century.

In San Francisco, Nancy Pelosi's friends have gotten the Presidio, Willie
Brown's friends are getting Treasure Island, and the giveaway of Hunters
Point has been delayed by discussions of who pays for the clean-up.

Barney Frank's bluster in response to a question about his medical
marijuana bill is indicative of why Al Gore and the Demos lost the 2000
election. If the Democratic leadership didn't have anti-democratic
instincts, they would have allowed Nader to debate and Gore would have won
the election by a theft-proof margin.

Nader would have come across as the Intellectual on the left, Bush as the
Dimwit on the right, and Gore would have been the solid Everyman in the
center, just where you want to be in a presidential race. Without Nader,
Gore came across as the wonk-liberal (the show-offy smart kid as an adult)
and Bush as the folksy conservative (the dumb but "popular" kid). Without
a left, the Demos don't look like the centrists they really are (at
best). Similarly, if the medical marijuana lobby the various "drug policy
reform" groups were pushing for Schedule III, Barney Frank could go to his
colleagues and say, "Look, there are these people out there who want to
make marijuana readily available and they're ahead in all the polls. My
bill requires triplicate prescription forms, strict government regulation,
etc. It's the compromise position." And he'd get a lot more co-sponsors
and yes votes than he has for HR 2592 having positioned himself as the hope
of the medical marijuana movement.

Given that the American people want marijuana legalized for medical
purposes by a very wide margin, Gore also could have won by coming out in
favor of it. He knew from personal experience that marijuana is safer than
alcohol; and he knew from watching his sister's ordeal that people dying of
cancer should not be denied any source of relief.

But Big Al took the "more research is needed" line, which, in practical
terms, means: more prohibition is needed. "Right now," said candidate Gore
in December '99, "the science does not show me or the experts whose
judgment I trust that it is the proper medication for pain and that there
are not better alternatives available in every situation.''

What's the difference between Gore's line and DEA Administrator Asa
Hutchinson's as set forth in a letter to the New York Times this week?
"Neither the scientific community nor the Food and Drug Administration has
concluded that smoking marijuana is medicine. The DEA supports the study
of marijuana for safe medicinal purposes.

It was because of studies approved by the agency that the drug Marinol was
developed.

Marinol is medical marijuana.

It is an FDA-approved prescription drug based on the active ingredient of
marijuana, THC. The DEA has authorized further studies of smoked marijuana
as medicine.

But until science concludes that smoking marijuana has a true medical
value, the agency is mandated by law to stop trafficking of this drug."
Hutchinson's letter ran the very day that the pain specialists were hearing
the known facts from the cannabinoid researchers in Reno.

Marinol is not medical marijuana and THC is not the only active ingredient
of marijuana.

Asa Hutchinson was mis-educated at Bob Jones University and Al Gore was
mis-educated at Harvard. The stall in the name of Science has been
conducted by Democrats and Republicans sophisticates and rubes with equal
duplicity.

Science itself has been captured by the corporations and the government,
and turned into something so unlike its true self that it's almost religion.