lobelsteve

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Some folks need all opiates, cocaine, thc, acid to be over the counter.

Then they can self medicate and leave doctors out of their own brand of crazy.
 
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drusso

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Some folks need all opiates, cocaine, thc, acid to be over the counter.

Then they can self medicate and leave doctors out of their own brand of crazy.
Steve, in Oregon, state policymakers favor moo-shu pork and Ganja-based pain management over science-based medicine. It's sprinkled with a healthy dose of collectivist/population-based ideology. Any evidence-based pain physician should oppose this nonsense:

Evidence for medical marijuana: The grass isn't always greener
John Murphy, MDLinx, 08/10/2015

The world has gone to pot—in more ways than one. In 1996, California became the first state to legalize medical marijuana. Since then, 22 other states, as well as Washington DC and Guam, have allowed its use in one form or another.


Medical marijuana is allowed in 23 states, but scientific studies lag behind. (Photo: ©

States vary in the type and amount of medical marijuana allowed and the indications for approved use. Some states, such as Massachusetts, permit the medicinal use of marijuana for only a handful of medical conditions. Other states, such as Illinois and New Hampshire, allow it as treatment for dozens of indications.

Unfortunately, reliable medical research hasn’t caught up to this legal progressiveness. Prescribers are caught in the middle as patients are increasingly asking about marijuana’s medical use, yet doctors aren’t armed with enough knowledge to provide proven advice.

Thus, the evidence of the benefits and the drawbacks of medical marijuana need to be further understood. Yet few rigorous, randomized clinical trials—the conventional proving ground for prescription medications—have been undertaken for medical marijuana.

To that end, a research team led by Penny F. Whiting, PhD, of the University of Bristol, Bristol, United Kingdom, scoured the literature by searching various databases for randomized clinical trials of cannabinoids for a variety of indications. The researchers identified 79 trials (including 6,462 participants) that met the rigorous criteria to be included in their review and meta-analysis. Few of the studies they found had evidence they deemed to be of even moderate quality; most of the studies were judged to be of low quality. Their results were published in an article in the June 23/30, 2015, issue of JAMA.

In short, the researchers concluded that most studies suggested that cannabinoids were associated with improvements in symptoms, but these associations did not reach statistical significance in all studies.

For specific medical conditions, here’s the evidence they found:

Indications with moderate-quality evidence

  • Chronic pain: The JAMA meta-analysis included 28 studies that assessed cannabinoids for a variety of chronic pain conditions—neuropathic pain, cancer pain, diabetic peripheral neuropathy, fibromyalgia, HIV-associated sensory neuropathy, among others. Overall, results showed that the number of patients who had a reduction in pain of at least 30% was greater with cannabinoids than with placebo.
  • Spasticity: Fourteen studies that assessed spasticity due to multiple sclerosis or paraplegia were included. Studies generally suggested that cannabinoids lessened spasticity—7 trials showed an average reduction in the Ashworth spasticity scale of -0.36—but results failed to reach statistical significance in most studies.
Indications with low-quality evidence

  • Nausea and vomiting due to chemotherapy: In 3 of the 28 trials included in the meta-analysis, cannabinoids showed a complete response in relieving nausea and vomiting in 47% of patients compared with 27% of patients on placebo. All trials showed positive results, but these didn’t reach statistical significance in all studies.
  • Appetite stimulation in patients with HIV/AIDs: In popular culture, smoking marijuana is believed to cause “the munchies.” Because people diagnosed with HIV and AIDS can lose their appetite, researchers have investigated medical marijuana for stimulating hunger in these patients. The meta-analysis included 4 studies, which showed limited evidence of stimulated appetite and weight gain; however, most outcomes failed to reach statistical significance.
  • Depression: The investigators could find no studies on use of cannabinoids for depression that met their inclusion criteria; however, 5 studies for other indications also reported depression outcomes. Nevertheless, most of these studies found no difference between cannabinoids and placebo in improving depression outcomes.
  • Sleep disorders: Drowsiness from smoking marijuana is another notion in popular culture. The researchers included 2 studies in their meta-analysis that evaluated cannabinoids for treating sleep problems. In addition, 19 placebo-controlled studies for other indications also evaluated sleep as an outcome. Overall, cannabinoids were associated with a greater average improvement in sleep quality (in 8 trials) and reducing sleep disturbance (in 3 trials).
  • Anxiety disorders: One small trial reported that cannabinoids, when compared with placebo, were associated with greater improvement on an anxiety scale during a simulated public speaking test. In addition, four studies that evaluated cannabinoids for chronic pain also included anxiety outcomes, and these suggested cannabinoids offered a greater benefit to patients with anxiety disorders than placebo.
  • Psychosis: Two trials included in the JAMA meta-analysis found no difference in mental health outcomes between cannabinoid and placebo treatment groups,
  • Glaucoma: The meta-analysis included only 1 small trial (of 6 patients) that evaluated cannabinoids for lowering intraocular pressure due to glaucoma. This trial found no difference between cannabinoids and placebo for glaucoma.
  • Tourette syndrome: Two small placebo-controlled studies (a total of 36 participants with Tourette syndrome) indicated that cannabinoids may significantly lessen severity of tics.
The studies included in this meta-analysis tested a variety of different cannabinoid preparations dosed in various routes of administration, including capsules, smoked marijuana, vaporized marijuana, oromucosal spray, and intramuscular injection. Bear in mind that marijuana has no single active ingredient, but is a complex of more than 400 compounds including more than 60 pharmacologic cannabinoids—the primary ones being tetrahydrocannabinol (THC) and cannabidiol (CBD). Only 2 cannabinoids—dronabinol and nabilone—are available as FDA-approved prescription medications.

Adverse effects

While the efficacy of medical marijuana requires further robust clinical trials, the adverse short- and long-term effects are much better known, the authors wrote. Acute effects of marijuana include impaired short-term memory, motor coordination, and judgment. Paranoia and psychotic disorder, although rare, may also occur in high doses. Long-term effects of frequent marijuana use include structural brain changes, chronic bronchitis, and increased rates of respiratory tract infections and pneumonia. Also, marijuana is potentially addictive in about 1 in 10 users.

“Evidence justifying marijuana use for various medical conditions will require the conduct of adequately powered, double-blind, randomized, placebo/active controlled clinical trials to test its short- and long-term efficacy and safety,” wrote Deepak Cyril D’Souza, MBBS, MD, and Mohini Ranganathan, MD, of the Yale University School of Medicine, New Haven, CT, in a JAMA editorial accompanying the meta-analysis. “Since medical marijuana is not a life-saving intervention, it may be prudent to wait before widely adopting its use until high-quality evidence is available to guide the development of a rational approval process.”
 
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Steve, in Oregon, state policymakers favor moo-shu pork and Ganja-based pain management over science-based medicine. It's sprinkled with a healthy dose of collectivist/population-based ideology. Any evidence-based pain physician should oppose this nonsense:

Evidence for medical marijuana: The grass isn't always greener
John Murphy, MDLinx, 08/10/2015

The world has gone to pot—in more ways than one. In 1996, California became the first state to legalize medical marijuana. Since then, 22 other states, as well as Washington DC and Guam, have allowed its use in one form or another.


Medical marijuana is allowed in 23 states, but scientific studies lag behind. (Photo: ©

States vary in the type and amount of medical marijuana allowed and the indications for approved use. Some states, such as Massachusetts, permit the medicinal use of marijuana for only a handful of medical conditions. Other states, such as Illinois and New Hampshire, allow it as treatment for dozens of indications.

Unfortunately, reliable medical research hasn’t caught up to this legal progressiveness. Prescribers are caught in the middle as patients are increasingly asking about marijuana’s medical use, yet doctors aren’t armed with enough knowledge to provide proven advice.

Thus, the evidence of the benefits and the drawbacks of medical marijuana need to be further understood. Yet few rigorous, randomized clinical trials—the conventional proving ground for prescription medications—have been undertaken for medical marijuana.

To that end, a research team led by Penny F. Whiting, PhD, of the University of Bristol, Bristol, United Kingdom, scoured the literature by searching various databases for randomized clinical trials of cannabinoids for a variety of indications. The researchers identified 79 trials (including 6,462 participants) that met the rigorous criteria to be included in their review and meta-analysis. Few of the studies they found had evidence they deemed to be of even moderate quality; most of the studies were judged to be of low quality. Their results were published in an article in the June 23/30, 2015, issue of JAMA.

In short, the researchers concluded that most studies suggested that cannabinoids were associated with improvements in symptoms, but these associations did not reach statistical significance in all studies.

For specific medical conditions, here’s the evidence they found:

Indications with moderate-quality evidence


Indications with low-quality evidence


The studies included in this meta-analysis tested a variety of different cannabinoid preparations dosed in various routes of administration, including capsules, smoked marijuana, vaporized marijuana, oromucosal spray, and intramuscular injection. Bear in mind that marijuana has no single active ingredient, but is a complex of more than 400 compounds including more than 60 pharmacologic cannabinoids—the primary ones being tetrahydrocannabinol (THC) and cannabidiol (CBD). Only 2 cannabinoids—dronabinol and nabilone—are available as FDA-approved prescription medications.

Adverse effects

While the efficacy of medical marijuana requires further robust clinical trials, the adverse short- and long-term effects are much better known, the authors wrote. Acute effects of marijuana include impaired short-term memory, motor coordination, and judgment. Paranoia and psychotic disorder, although rare, may also occur in high doses. Long-term effects of frequent marijuana use include structural brain changes, chronic bronchitis, and increased rates of respiratory tract infections and pneumonia. Also, marijuana is potentially addictive in about 1 in 10 users.

“Evidence justifying marijuana use for various medical conditions will require the conduct of adequately powered, double-blind, randomized, placebo/active controlled clinical trials to test its short- and long-term efficacy and safety,” wrote Deepak Cyril D’Souza, MBBS, MD, and Mohini Ranganathan, MD, of the Yale University School of Medicine, New Haven, CT, in a JAMA editorial accompanying the meta-analysis. “Since medical marijuana is not a life-saving intervention, it may be prudent to wait before widely adopting its use until high-quality evidence is available to guide the development of a rational approval process.”
Nice review. But they failed to mention the increased rates of mva's on marijuana vs etoh, at legal blood serum levels. As well as known gynecomastia in males...
 

lobelsteve

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Nice review. But they failed to mention the increased rates of mva's on marijuana vs etoh, at legal blood serum levels. As well as known gynecomastia in males...

So that's your excuse?
 

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So that's your excuse?
Funny... The NEJM review article last year was very susinct and equally concerned about widespread usage as a public safety hazard(mva's, bronchitis, schizophrenic, youth brain alterations)... I like to tell males they are going to grow boobs...
 

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I'm confused. Are some of u against people having legal access to mariajuwanna to treat their pain? If so, what business is it of yours what side effects there are? They want pain relief and sometimes nothing else works or they'd rather not use conventional meds.

Also, no one gives a flying Sarah Palin about studies critical of efficacy with regards to treating pain. If it works me, it works for me....is the general attitude.
 
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I'm confused. Are some of u against people having legal access to mariajuwanna to treat their pain? If so, what business is it of yours what side effects there are? They want pain relief and sometimes nothing else works or they'd rather not use conventional meds.

Also, no one gives a flying Sarah Palin about studies critical of efficacy with regards to treating pain. If it works me, it works for me....is the general attitude.
It's a violation of federal law boss... And the studies supporting its use is questionable at best... If you are dying of cancer, I'd be happy to write some marinol for you, but not a joint...
 
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We want our patients to receive safe and effective care. The evidence based medicine - from here or countries where it is legal - is not strong enough.

As physicians, we do no harm. Recommending a therapy with no proven (or even suggested positive) efficacy is not in the patients or physicians best interest.

Especially if use of such substances can adversely interfere with medications that are prescribed by said physician, and especially if those substances can be prescribed only by the graces of the federal government...
 

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We want our patients to receive safe and effective care. The evidence based medicine - from here or countries where it is legal - is not strong enough.

As physicians, we do no harm. Recommending a therapy with no proven (or even suggested positive) efficacy is not in the patients or physicians best interest.

Especially if use of such substances can adversely interfere with medications that are prescribed by said physician, and especially if those substances can be prescribed only by the graces of the federal government...
I disagree... I don't prescribe illegal schedule I medical therapies in most situations. I make exceptions for palliative cancer pain only. If you don't believe in the rule of law, more power to you... We are a society of laws, not rogue doctors writing marijuana for PTSD, Crps, psoriatic arthritis, etc. just my opinion based and full assessment of the literature, public health consequences, and personal experience...
Read this before you prescribe marijuana based on state laws:
http://www.justice.gov/iso/opa/resources/3052013829132756857467.pdf
 
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I find no convincing evidence that MJ provides pain relief. The best study I read regarding MJ vs a true placebo was out of Canada and it showed no difference in pain scores. Small study but it was well designed. I find those who use MJ are the "chemical coping" crowd. The patients who tend to be on narcs, soma, multiple antidepressants, benzos....you name it; just so they can become numb to reality.
 
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I'm confused. Are some of u against people having legal access to mariajuwanna to treat their pain? If so, what business is it of yours what side effects there are? They want pain relief and sometimes nothing else works or they'd rather not use conventional meds.

Also, no one gives a flying Sarah Palin about studies critical of efficacy with regards to treating pain. If it works me, it works for me....is the general attitude.
You made a wrong turn into the wrong forum. A DEA or Congressional discussion board is where you need to go. We don't make the rules or enforce the rules. They do. But we have to play by them to stay out of jail, and keep our DEA licenses and jobs. You're barking up the wrong tree and wasting your time. Goodbye.
 
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I disagree... I don't prescribe illegal schedule I medical therapies in most situations. I make exceptions for palliative cancer pain only. If you don't believe in the rule of law, more power to you... We are a society of laws, not rogue doctors writing marijuana for PTSD, Crps, psoriatic arthritis, etc. just my opinion based and full assessment of the literature, public health consequences, and personal experience...
Read this before you prescribe marijuana based on state laws:
http://www.justice.gov/iso/opa/resources/3052013829132756857467.pdf
Yes. All it takes is a change of executive branch administration to have those federal anti-marijuana laws enforced again in all states, including those where the states made it legal on a state level. At least one Presidential candidate has already pledged to do so (Gov. Christie). If that happens, all the legal-weedsters in the legal-weed states are ----ed.

http://m.huffpost.com/us/entry/7066636
 

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Stim, I do not understand how you are disagreeing with me. Did you even read my post? Where in it do I imply that it is remote possibility a pain physician would consider prescribing or condoning use of marijuana?
 

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Oh wait, nm. It just dawned on me that the phrasing and not so esoteric language I used was beyond stim's grade level.


Let me simplify - Ganga doesn't help, it's illegal and the law will getcha if you prescribe.....
 

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Oh wait, nm. It just dawned on me that the phrasing and not so esoteric language I used was beyond stim's grade level.


Let me simplify - Ganga doesn't help, it's illegal and the law will getcha if you prescribe.....
Yes Ducctape you are right... I misread your posts as 'whether it's' vs 'where it's'... My bad. In response to your intelligence dig, I will stay calm and channel my inner Donald Trump and only say that I am better trained and more successful. I would follow by saying this country needs to either uphold its drug laws or change them. This pseudo federalism for marijuana rights makes no sense...the next president needs to take an actual stance, and I believe Hillary is being forced to address the drug problem in NH, a critical state for her campaign...let's see how she can tackle the substance abuse issue while allowing for violation of federal drug laws.
 
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drusso

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I disagree... I don't prescribe illegal schedule I medical therapies in most situations. I make exceptions for palliative cancer pain only. If you don't believe in the rule of law, more power to you... We are a society of laws, not rogue doctors writing marijuana for PTSD, Crps, psoriatic arthritis, etc. just my opinion based and full assessment of the literature, public health consequences, and personal experience...

Read this before you prescribe marijuana based on state laws:
http://www.justice.gov/iso/opa/resources/3052013829132756857467.pdf
No evidence-based pain physician should turn a blind eye to patient safety--i.e. the concomitant use of cannabis and opioids. It's an issue that requires and justifies scrutiny and surveillance.
 
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Ducttape

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i was being facetious


that means joking.


in magenta?


we all measure success differently. you indubitably generate greater income, have your own successful private practice, have more cars (and nicer ones), houses, $$, mistresses, than me, unquestionably. without a doubt, you will definitely die with the most toys.

but...


you ever get an SSD patient back to work?

how many???
 

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i was being facetious


that means joking.


in magenta?


we all measure success differently. you indubitably generate greater income, have your own successful private practice, have more cars (and nicer ones), houses, $$, mistresses, than me, unquestionably. without a doubt, you will definitely die with the most toys.

but...


you ever get an SSD patient back to work?

how many???
I focus on wc patients, they have jobs to go back to... And yes I get a lot of wc patients back to work, with no opioids, and continue to get more referrals and $$$$$$$$ because of my care.... Medicaid ssd is pointless... You can tune them up, but unless you can get them a job paying more than 40k, they are better of on the DOLE....but it's noble work you are doing, hopefully a good economy will get those ssd patient into the actual workforce... Also Ducctape remember most studies show wealth provides for stability, better health and indirectly more happiness.. So don't feel bad for me.... That is condescension in magenta...
 

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lonelobo

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Ducc we can tango all night if you like....I'm just a little busy making it rain today... As trump says, don't be ashamed of being successful and smart. Make others around you richer, and happier, I know I do.... Economic nationalism is the answer...
http://www.businessinsider.com/study-shows-money-can-buy-happiness-2015-1

http://www.wsj.com/articles/can-money-buy-happiness-heres-what-science-has-to-say-1415569538
You give guys in PP a bad name. It is fine to be confident, but being a pompous A$$ is another story
 

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You give guys in PP a bad name. It is fine to be confident, but being a pompous A$$ is another story
Dude it was joke... Calm down. Plus what's wrong with being successful... I'm not a socialist, I'm a capitalist... Funny how you people attack like a bunch drama queens... Sorry to break it you but people can make money if they own their own business , provide GREAT care, take minimal vacation, and don't pay the administrators... Im sorry a few of you are so jealous and comabative.... As much as you want to believe I'm ugly, fat, dumb, arrogant, obnoxious, etc, maybe you should look in the mirror... I'm as happy as can be...clearly a few of you find a need to attack my opinions, which by the way are correct the majority of the time...have a good day, I know I am
 

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Dude it was joke... Calm down. Plus what's wrong with being successful... I'm not a socialist, I'm a capitalist... Funny how you people attack like a bunch drama queens... Sorry to break it you but people can make money if they own their own business , provide GREAT care, take minimal vacation, and don't pay the administrators... Im sorry a few of you are so jealous and comabative.... As much as you want to believe I'm ugly, fat, dumb, arrogant, obnoxious, etc, maybe you should look in the mirror... I'm as happy as can be...clearly a few of you find a need to attack my opinions, which by the way are correct the majority of the time...have a good day, I know I am
You are wrong for making that money. You will feel better if you give me some of that money. My birthday is in February. I like turbos.
 

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Yes , I can only verify 2 for sure.
I like you lonelobo, you keep me on my feet ;).... Steve 2010 turbo for sale, mint condition, 85k... It provides pure happiness....FYI i invest, not all my $$ is in medicine, does that make everybody feel better...
 

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Stim, take s minute and actually read the wsj article you are quoting... You will be disappointed in the context.

No offense, but you have a lot of suppressed anger and aggression by your various posts. Sounds like you are okay with that tho

Have fun with all that money. I can tell you from personal experience that you don't need as much as you have to be happy and content...
 

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Stim, take s minute and actually read the wsj article you are quoting... You will be disappointed in the context.

No offense, but you have a lot of suppressed anger and aggression by your various posts. Sounds like you are okay with that tho

Have fun with all that money. I can tell you from personal experience that you don't need as much as you have to be happy and content...
This argument can go on forever... Money provides personal freedom, better health, and possibly more happiness... Clearly too much can be bad , but so can poverty... I appreciate the psychoanalysis buddy, but you are wrong, and you might want to take some time to evaluate your need to be so contentious, combative, narcissistic and anti libertarian and capitalistic. You mentioned your internal daddy conflicts in the past, maybe you are overcompensating and venting daily on SDN.... Just a thought:bang: for fun let's start a happiness tread and prove our points...this tread has gone awry
 
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lobelsteve

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Back on topic:

If Marijuana was legal and i could try it without tisk of losing my job im unsure i would try it fue to psychosomatic issues where i will certainly feel paranoid. And there is no way i could smoke it. So when it goes otc i will need a pot brownie recipe.
 

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Back on topic:

If Marijuana was legal and i could try it without tisk of losing my job im unsure i would try it fue to psychosomatic issues where i will certainly feel paranoid. And there is no way i could smoke it. So when it goes otc i will need a pot brownie recipe.
In college I thought a tree was following me...
 

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Back on topic:

If Marijuana was legal and i could try it without tisk of losing my job im unsure i would try it fue to psychosomatic issues where i will certainly feel paranoid. And there is no way i could smoke it. So when it goes otc i will need a pot brownie recipe.
Try a vaporizer