Australian Medical Association warns of cannabis risk from Greens plan

Tom McIlroy

Canberra-doctors do not support a proposed medical cannabis scheme for the ACT, representatives of the Australian Medical Association told a Legislative Assembly committee.

Giving evidence at a public hearing on Tuesday, ACT association branch president Elizabeth Gallagher rejected a proposal from Greens Minister Shane Rattenbury for medical cannabis, describing it as "too ad hoc" and without strict enough regulation to be safe and effective.

Dr Gallagher said the scheme's proposal for doctors to provide permits to patients for growing their own medical cannabis plants would be problematic and open to misuse.
Last month the association called for more clinical research and for a national approach to cannabis being used for health outcomes. Dr Gallagher appeared at the hearing with AMA chief executive Christine Brill.

"We have a responsibility to patients to make sure that what we are prescribing for them [is something] that we understand," Dr Gallagher said.
"We would really like to be able to get a quality controlled, targeted product out, if we are going to use it – rather than just the crude [cannabis] product which is more like a sledge hammer."

The hearing was told that cannabis had been illegal and unregulated in Australia for more than 90 years and was currently the most widely used illicit drug in the community.
Dr Gallagher said widespread access meant the drug remained open to misuse and abuse and any regulation for a medical scheme in the ACT should be more strictly controlled than the current legislation.

Calling for an evidence-led debate, she said there was no anecdotal or documented levels of current unregulated use of cannabis by sufferers of medical conditions, including cancer,  in the Canberra community.
"We start to lose the objectivity once we see pictures of little kids fitting, of this sort of story. It really takes away from what we really want, which is a scientific, evidence-based response to problems.
"It is very easy for people to talk anecdotally without proper information to back those sorts of statements up."

Mr Rattenbury's proposed scheme would allow terminally and chronically ill people to grow cannabis and use the drug as part of their treatment.
Released in draft form last year, it would see sufferers of terminal and chronic illness apply to the ACT Chief Health Officer for approval to possess and use cannabis.  Patients using cannabis and oils, often illegally, report relief from pain and suffering, including nausea.

A medical scheme received support on Tuesday from advocates Families and Friends for Drug Law Reform and the Public Health Association of Australia, but was opposed by controversial lobby group Drug Free Australia.
Political campaign organisation, the Australian Christian Lobby,  said it was not affiliated with Drug Free Australia, as was reported on Tuesday.

Managing director Lyle Shelton wrote to the Assembly's Health, Ageing, Community and Social Services Committee in February calling for scientific trials of cannabis for medicinal purposes, so it could be tested against the same standards as any other drug.
"If cannabis has a genuine palliative effect that other drugs cannot provide, it should be available to patients in the same way other medications are," Mr Shelton said.

"However, ACL is concerned by the proposal to decriminalise the possession, cultivation, and use of the cannabis plant, especially before a thorough trial has taken place."
Health risks from cannabis use raised by experts meant "a more cautious, scientific approach to developing medicinal cannabis treatments" was needed rather than decriminalisation, Mr Shelton said.

Marijuana's Early History in the United States

 

By Mark Hay

America is a weed nation. Love it or hate it, you or someone you know inevitably has a deep tie to the ubiquitous herb. And with four states now declaring recreational pot legal and 19 more supporting medical marijuana, weed's set to become not just an unavoidable illicit experience, but an integral and nonchalant part of our culture. Given its prevalence in modern life, it's only natural that we assume pot's been a part of our culture for ages, just now coming into the light. Sure, it's not an indigenous American crop (weed originated somewhere in Central Asia, then spread across the Old World over thousands of years), but it's easy to think that it must have come to America in days of yore and taken root from there.

Yet, the truth is that most histories of weed's origins in America are spotty at best. We know that in the 1930s, weed became the primary target of the nascent post-Prohibition drug wars. We know that our names for it, like marijuana, reefer, and dope, have their roots in Spanish and African American and Caribbean slang. Yet what weed's place was before the 1930s and what these two groups had to do with its American history are pretty murky.

If you go a-googling, chances are you'll see a host of stories about the origins of weed in the Americas. Some folks boldly claim that cannabis came over with Columbus in 1492 and just set up shop. Some say that it first emerged in the 16th century in Brazil and Chile and spread out from there. Possibly the most common account holds that weed came to America in the form of hemp plantations that proliferated in 17th century American colonies. Many seem to directly link this hemp to the smokeable marijuana of today, implying that somehow we began toking on what started out early on as a crop.

All we really know for sure about the emergence of weed-the-narcotic in America is that accounts of its recreational and medicinal use start popping up along the east coast in the 19th century. It became exceptionally prevalent in the South in the early 20th century. And this explosion of usage made it a target for the embryonic Drug Enforcement Agency. 

A bit frustrated by all of these possible points of entry and the lack of any firm narrative of weed's emergence and entrenchment in American culture, I called up Barney Warf. A professor at the University of Kansas, Warf is an authority on the global spread of smokeable pot—last year he published a paper entitled " High Points: An Historical Geography of Cannabis." He was more than glad to tell me why proof of hemp in the early colonies cannot be described as the origins of narcotic weed, how smokeable pot really came to America, and how its origin and modes of transmission were key to its opposition in early 20th century politics.

VICE: There's a lot of vague, disjointed information out there about how the smokeable narcotic we know today came to America. So let's get down into the historical weeds here.

 

A lot of people point to the hemp plantations of 17th century America, like the ones at the colony of Jamestown, as the origins of cannabis in America. But hemp's not the cannabis you smoke. So is there any real connection between weed as we know it and the colonies?
It's important, first of all, to differentiate between the different types of cannabis. There are four species within the genus. 

One is cannabis sativa L, and that's what we call hemp. That's what was grown in both the British colonies on the East Coast and by the French in Quebec. But hemp is less than one percent THC, so you really can't get stoned off of hemp. It was used for bales and ropes and sometimes paper and clothing and things like that [and that's all].

The other species of cannabis are cannabis sativa (without the L), which is much higher in THC and has become much more potent over the years. [Then there's] cannabis indica and ... cannabis ruderalis , the last of which was discovered by a Russian scientist in 1923. But that one's almost invisible. 

So yes, there was hemp grown in the colonies. But as far as I know, no smokeable weed.

When and where did weed as a narcotic enter the New World?
It [was] brought to the Americas by the Portuguese, who took it to Brazil, and again by the British, who took it to Jamaica. In both cases, it was used to pacify slaves. 

How did people there go from seeing weed as a tool of slavery to seeing it as a fun drug?
Well, it doesn't take a big leap of logic. You had cannabis being grown by the British East India company. [They] grew it in Bengal and India and exported it to Guyana, South Africa, and Jamaica. [They] taxed it heavily and encouraged its plantation well after slavery ended there.

It was sold in company stores in Jamaica [for instance] well up into the 20 ^th century. Slave-like conditions persisted in the sugar cane fields [there] well into the 20 ^th century, when there was this widespread mechanization of sugar cane production. 

Until the production of sugar cane ended, I think people were smoking cannabis for much the same reasons. It just became part of Jamaican culture [and in other places it was grown and smoked from the slave-era on].

There were [also] large Indian populations in the Caribbean. Indentured Indian workers who worked alongside blacks were probably another vehicle by which [smokeable, recreational marijuana] was brought into [the Caribbean, for example] at the time. 

It [was] brought to the Americas by the Portuguese, who took it to Brazil, and again by the British, who took it to Jamaica. In both cases,It was used to pacify slaves.

Getting back to the United States proper, how did weed-the-narcotic make its jump from South America and the Caribbean into America, and when?

The introduction of smokeable cannabis to the US largely begins after the Mexican Revolution of 1910 to 1911. There were a number of refugees crossing the border from the violence of the revolution at the time, and they brought smokeable cannabis with them. There had been a long tradition of smokeable cannabis in Latin America [after its introduction to the region via plantations] and networks of marihuaneros [pot growers] in Spanish-speaking countries. 

The immigrants fleeing the violence in Mexico brought cannabis into the southwestern US, particularly Texas. It was there that the first backlash against cannabis began. El Paso became the first city to have an ordinance against it in 1914.

What impact did that have on the way we look at pot today?
These Mexican roots of American smokeable cannabis are important because it was known as a colored-people's drug well into the 1960s when the baby boom discovered it and white college kids began to smoke it and it lost its racial connotations.

There was also cannabis being brought into places like New Orleans by sailors and sometimes by immigrants from the Caribbean [around the same time]. The black community also began to pick up on cannabis, so that reinforced this racial stereotype that brown and black people smoke cannabis and white people did not.

Because it was used by black Americans and Mexican Americans, it helped to feed into the racist fears and stereotypes that were used to make it illegal in the 1930s.

How did that happen?
When Harry Anslinger, who was leading a federal agency that would later become the Drug Enforcement Agency, was confronted with the end of prohibition in 1933, he panicked because he and his man were charged with enforcing prohibition... He was worried that he didn't have a mission in life, that he and his men would be out of a job. That's when he began to lead the crusade against marijuana. They very deliberately, systematically chose marijuana as their new whipping boy.

When Anslinger was participating in federal hearings that would eventually culminate in the passage of the Marijuana Stamp Act in 1937, which essentially made marijuana illegal, the arguments against marijuana use were not at all grounded in scientific evidence. They were grounded in hearsay and stereotypes: That this was a drug black men used to seduce white women. That it was a drug that led Mexicans to murder their white neighbors.

But there were accounts of cannabis use of some kind in America before the Mexican Revolution. In the 19th century, there was that book, The Hasheesh Eater, about hash use in the Northeast, for instance. Where does that fit into this story of weed's American roots?
Hash had been used in Europe widely going back to the 16th and 17th centuries.

[In the 19th century] French soldiers who'd returned from Napoleon's invasion of Egypt brought hash with them. In Paris, there was a group called the club des hashischins that included many of France's most famous writers like [Charles] Baudelaire, [Gustave] Flaubert, [and Honoré de] Balzac.

New York had extensive linkages to continental Europe. There were circuits of writers and scholars and musicians who went back and forth. It doesn't surprise me that some of that hash would find its way into New York through those transatlantic circuits.

But it never proliferated, I'm guessing, because it was more like a luxury import or something you did abroad? So it'd be like well-heeled Americans going on vacation now and trying ayahuasca vines and maybe bringing back a bit at great expense?
That's an interesting analogy. It does kind of make some sense.

Hash was also much more expensive than cannabis because it's purified resin. Not many people could afford it.

[Side note:] Cannabis actually never really caught on in the Amazonian part of Brazil because it couldn't compete with the indigenous drugs that the native population there had [like ayahuasca]. 

OK, so you said the Mexicans coming into America were the main way that weed spread north. But you also mentioned Caribbean sailors. Who came first and who was more important to the establishment of weed in America?
Honestly, I can't give you a good answer. I'm not sure anybody knows. This part of the history of cannabis is very sketchy. We know that it got entwined with jazz very early on, much of which came out of New Orleans [and used that to spread north]. But whether the Caribbean or Mexican route came first, I can't give you an honest answer. I suspect that it may have been simultaneous. But I think that the Mexican influence was much bigger and more important. 

Why? Because they were the less insular communities?
Right.

In some respects, the [widespread] use of marijuana may have been an ironic and unintentional outcome of Prohibition.

So we have these Caribbean and Mexican communities smoking weed in the 1910s in America. How does weed become so widespread and popular?
[At first] it may have been largely confined to the Mexican and Mexican-American communities in Texas and confined largely to the black community in New Orleans ... but it had to have grown in popularity or Anslinger wouldn't have chosen it as his demon of choice.

Does that mean it just spread through gradual contact with immigrant communities?
Right—as far as I can tell. I wish we had a much more detailed account of this.

In Texas, the boundaries between the immigrant community and American Latinos was a very porous one. There was a great deal of intercourse between them, so it's not a surprise that [marijuana] became widespread among the Hispanic community of the southwest.

The Caribbean connection actually surprises me much more [because they were insular].

Was there anything else that helped marijuana to get so popular within two decades?
It was especially popular as an alternative to alcohol, which was illegal [in the 1920s]. In some respects, the [widespread] use of marijuana may have been an ironic and unintentional outcome of Prohibition. I don't have firm evidence to justify that claim. But it does make sense.

Marijuana Facts and Myths: Health Officials Explain Risks of Pot

There is a plethora of marijuana facts and myths being discussed all over the world by both opponents and proponents of the drug. On the one side of the debate are adversaries of marijuana legalization, who try to get their point across by explaining the health risks of the drug.

In the past, they have cited the negative effects that marijuana has on the brain and lungs. Nowadays, however, they’re also citing facts about marijuana usage and how it causes problems below the belt.

The following are some marijuana facts that health officials have been promoting:

Impact on Sex Drive
There are references among the ancient Romans that marijuana use could hinder the sex drive, and that, during the Middle Ages, Muslim doctors used the plant to blunt sex drive.

Rany Shamloul, a postgraduate fellow at Queen’s College in 2011, conducted a study in which he found the use of marijuana could negatively impact a man’s sexual function. Shamloul told the Queen’s Journal that, “A key message that needs to be passed to the younger generation is this: Think twice before you smoke marijuana, because cannabis you use today may adversely affect your sexual performance in years to come.”

From Britain: Effects on the Brain and Lung
Health officials across the world believe there are other issues. In England, a 2007 study authorized by the government came to the conclusion that marijuana could lead to mental illness and that it perhaps played a role in one in seven mental illness cases.

That study prompted a lot of hand wringing by British leaders and physicians, including a quote from Robin Murray, a professor at London’s Institute of Psychiatry. She told the Independent that, “The number of people taking cannabis may not be rising, but what people are taking is much more powerful, so there is a question of whether a few years on we may see more people getting ill as a consequence of that.”

It’s not just the brain. The British Lung Foundation, in a 2002 report, stated that three to four marijuana joints a day could lead to the same type of bronchitis caused by the daily use of 20 regular cigarettes.

Problems for the Future
And, if it’s not happening to you, health officials stress it could happen to the next generation. Andrea Barthwell, the former deputy director of the White House Office on National Drug Control Policy, said that the rough edge was taken away from marijuana with some legalization. She also said that, “Children entering drug-abuse treatment routinely report they heard that pot is medicine and, therefore, believed it to be good for them.”

Marijuana Legalization Nationwide Postponed Until April — And Will Likely Get Postponed Again?

Have you heard that marijuana was going to be legalized on March 25 — and then heard nothing about it again in the news? In the past six months, marijuana legalization advocates have been hanging onto the edge of their seats about a court case in Northern California that is set to legalize marijuana nationwide. However, the case that was set to be decided on during March 25 was officially postponed to a date that is awfully close to the unofficial 420 holiday celebrated on April 20.

But there is no reason to hope that marijuana will become legal on 4/20 in 2015 because even if a big decision is made — this is not over yet. Unfortunately, according to Jeremy Daw, it looks like the postponement could have more marijuana legalization postponements involved.
Outside of this legal marijuana USA story, most of the news surrounding marijuana has been linked to headlines about an heiress getting sued for producing too much smoke around her apartment.

States in the process of legalizing marijuana are also trending news topics. Nonetheless, it looks like those states may not need to vote individually as states because marijuana may be legalized nationwide in the future — but maybe not in the near future.
How will federal marijuana legalization happen? As previously posted on the Inquisitr by this author, updates about the marijuana hearing in Northern California that could inevitably help marijuana become federally legal are not posted online. Instead, the schedule for the marijuana legalization hearing is distributed only by text message — and the Eastern District of California legal blog is one of the sole sources of online information for this historically critical marijuana legalization hearing.

In short, the USA versus Schweder trial that is now taking place on April 15 in Northern California is important because it will reschedule marijuana from a hard drug to a softer substance like alcohol. If the court case favors marijuana, it can then go to the Supreme Court, where they will decide if not favoring marijuana in this way infringes on people’s rights.
The Eastern District of California legal blog points out that if the Supreme Court finds evidence that there are rights infringements, marijuana will become legal across America. The blog also states the following.

“This is the case where the court held an evidentiary hearing on the defense’s motion to dismiss federal marijuana charges on the grounds that (1) the feds’ classification of marijuana as a Schedule I controlled substance without any accepted medical use is unconstitutional; and (2) the uneven enforcement of federal marijuana laws violates the Equal Sovereignty principle in the Constitution. [sic]”

Those interested in knowing more about this historic marijuana case have several legal documents they can sift through. Nevertheless, unless you have a law degree and a few days on your hands, legal cases involving hundreds of pages can be difficult to decipher.
Providing a clarification of the case related to the legalization of marijuana taking place in Northern California on April 15 is Jeremy Daw. Daw wrote an article for Leaf Magazine fully explaining the current status of the entire USA versus Schweder case in a language anyone can understand.

As a 2008 Harvard Law graduate and Professor of Economics at the marijuana-focused Oaksterdam University, Daw definitely has one of the most credible voices in analyzing this particular hearing. In the short synopsis he wrote, Daw explains there are several directions the case on April 15 can follow — not all of which mean marijuana will be legalized. Daw states the following.

“If my prediction is correct and Judge Mueller rules for the defense on the merits, the prosecutors can be expected to immediately move for an appeal and a temporary stay on her ruling until the matter can be heard by the 9th Circuit. Such a move could easily delay any ruling from taking effect until next year… Nevertheless, it would still be a huge win. Just as Judge Walker’s Prop 8 decision had a massive effect on the national politics of gay marriage… [sic]”

Medical marijuana users could help researchers define risks, benefits

The Canadian Medical Association says we don’t know enough about the effects of medical marijuana, the interactions between pot and other medications, or how to prescribe an appropriate dosage. It advises doctors they are not obligated to write cannabis prescriptions for patients. (Jonathan Hayward/Canadian Press)

Besides pain management, pot is being used to treat things like Crohn’s disease, chronic seizures

By Talin Vartanian,
The number of Canadians authorized to use medical marijuana has skyrocketed, even as medical experts warn that not enough is known about its risks and benefits. Now some are calling for researchers to tap into that growing pool of users to help answer some of those questions.
In 2002, a year after the government first permitted access to therapeutic cannabis through Health Canada regulations, 500 patients had registered. Today, there are more than 50,000.
This has happened despite the official position of the Canadian Medical Association (CMA) which says that, "there is insufficient scientific evidence available to support the use of marijuana for clinical purposes."

In 2002, a year after the government first permitted access to therapeutic cannabis through Health Canada regulations, 500 patients had registered. Today, there are more than 50,000. (Darryl Dyck/The Canadian Press)

​The CMA says not enough is known about the effects of medical marijuana, the interactions between pot and other medications, or how to prescribe an appropriate dosage. It advises doctors they are not obligated to write cannabis prescriptions for patients.
That is causing frustration for some people with medical conditions who want the option of using medical marijuana rather than other types of prescription drugs.

"It was very difficult to get my prescription," said Jennawae McLean, who uses medical marijuana for chronic pain due to arthritis. "A doctor was willing to prescribe me Percocets and Humira and Lyrica and different pills like this, but they weren’t willing to prescribe cannabis … which has no recorded deaths, no overdoses, no negative long-term side effects. It just doesn’t make sense."

Medical marijuana is sometimes sold in the form of skin creams, edibles, oils, tinctures or topical medicines, even though this contravenes Canadian law. (The Canadian Press/Jonathan Hayward)

​A 2014 poll conducted by Angus Reid Global showed that 59 per cent of Canadians support the legalization of marijuana. However, the Conservative government is opposed to legalization beyond medicinal uses.
Government guidelines for the medicinal use of pot are outlined in Health Canada’s Marihuana Medical Access Regulations (MMAR) and state clearly that prescriptions may be written only by a physician or nurse-practitioner; that medical marijuana must be purchased through a licensed producer, and only as dried plant material; and that it cannot be sold through a storefronts or retail outlets.

Thousands of Canadians are flouting those regulations, and nowhere more than in British Columbia. There are now more medical marijuana shops in Vancouver than there are Tim Hortons - and more shops than in the rest of Canada combined. These stores are selling cannabis and hashish with names like Purple Kush, West Coast Rockstar, Polar Hash and even Barbara Bud, in addition to a variety of edible marijuana products. On-site naturopaths provide medical marijuana access cards, in some cases to those who simply say they are feeling stressed.
Vancouver police are enforcing a prohibition on selling marijuana to minors, however they focus their criminal enforcement efforts on the trafficking of more serious street drugs, such as cocaine, heroin and methamphetamines.

Most of the research into the effectiveness of medical marijuana so far has focused on pain management. However, patients are using it for a variety of conditions ranging from Crohn’s disease to chronic seizures. (CBC)

​Vancouver city councillor Kerry Jang said that, based on what has happened in Vancouver, he believes Canada already has de facto legalization of marijuana. "And quite frankly, I’m glad it’s above ground in a dispensary where we can regulate and see what’s going on, rather than underground."  
Now some are saying that studying this growing base of medical marijuana users could be the way for the medical community to fill gaps in our understanding of its risks and benefits.

Researchers have published thousands of peer-reviewed articles about medical marijuana, mainly on the therapeutic properties of the various cannabinoids found in cannabis plants. But "when you narrow the search down to clinical trials, the number drops dramatically," said Dr. Mark Ware, executive director of the Canadian Consortium for the Investigation of Cannabinoids.
​ 
"If you think about conventional pharmaceutical drug development, there is usually a company behind a new drug that’s investing hundreds of millions of dollars in doing those clinical trials in order to make a claim that this drug, at this dose, is effective in the treatment of this symptom, in this disorder," said Dr. Ware, who is also the director of clinical research at the Alan Edwards Pain Management Unit at the McGill University Health Centre.

Dr. Mark Ware says the medical community would benefit from “real world evidence,” which could be gathered by monitoring the progress of the thousands of patients who are using therapeutic marijuana. (Tori Weldon/CBC)

​After government approvals, a conventional pharmaceutical drug is launched on the market and the company recuperates its investment. The problem, Dr. Ware says, is that, "there isn’t such an interest in investing in that work for herbal cannabis, which is something you can grow in your backyard."

Most of the research into the effectiveness of medical marijuana so far has focused on pain management. However, patients are using it for a variety of conditions ranging from Crohn’s disease to chronic seizures.
Dr. Ware says the medical community would benefit from "real world evidence," which could be gathered by monitoring the progress of the thousands of patients who are using therapeutic marijuana.
Meanwhile, patients who want legitimate access to medical marijuana are caught between the government regulations and doctors who don’t feel they have enough information about it to provide a prescription. And most doctors who are willing to write marijuana prescriptions do not endorse smoking the drug, recommending instead that patients use it in a way that will not be potentially harmful to their lungs. 

This may include edibles, oils, tinctures or topical medicines, none of which may be sold legally under current federal rules - although it is legal to buy dried weed with a prescription and make your own.
Vancouver resident Owen Smith has challenged that law all the way to the Supreme Court of Canada. It heard arguments on March 20 and has reserved judgment in the case. It can take at least six or seven months for the Court to publish its decision, which will be near the date of the next federal election, Oct. 19.

---

Medical marijuana and the new herbalism, part 3: Cannabis does not cure breast cancer

Stefanie LaRue

It’s been a while since I discussed medical marijuana, even though it’s a topic I’ve been meaning to come back to since I first dubbed medical marijuana to be the equivalent of herbalism and discussed how the potential of cannabinoids to treat cancer has been, thus far, unimpressive, with relatively modest antitumor effects. The reason I refer to medical marijuana as the “new herbalism” is because the arguments made in favor of medical marijuana are very much like arguments for herbalism, including arguments that using the natural plant is superior to using specific purified cannabinoids, appeals to how “natural” marijuana is, and claims of incredible effectiveness against all manner of diseases, including deadly diseases like cancer, based on anecdotes and testimonials.

Now, as I pointed out before, not only am I not opposed to the legalization and regulation of marijuana for recreational use, even though I’ve never tried it myself, but I support it. What I do not support are claims for medical effects that are not backed up with good scientific evidence, and for medical marijuana most claims fall into that category. That’s why I tend to view medical marijuana as a backdoor way to get marijuana legalized. Personally I’d rather advocates of marijuana legalization drop the charade, argue for legalization, and stop with the medical nonsense.

The last time around, I discussed the evidence supporting claims that “cannabis cures cancer” and found them to be wanting based on science. I didn’t however, discuss the “cannabis cures cancer” testimonial machine that drives the claim that marijuana is useful for treating cancer; at least, I only touched on it by discussing briefly Rick Simpson, who claims that his hash oil cures approximately 70% of patients with terminal cancer and a published anecdote in which it was claimed that hemp oil was effective in treating acute lymphoblastic leukemia.

(It wasn’t. At least, the evidence presented was not convincing.) Since then, I’ve wanted to revisit the topic of “cannabis cures cancer” testimonials, and, for whatever reason, now seems like a good time to do it, not the least of which because there was recently a BBC news report by Alastair Leithead that presented a desperate patient with stage IV presenting cannabis as her last hope for survival. It also featured a cancer patient by the name of Stefanie LaRue who claimed that cannabis had been highly effective against her stage IV breast cancer, even going so far as to add an additional claim, namely that she used only cannabis, no chemotherapy. In this, the news story was horrible and highly misleading, because LaRue’s story, as you will see, is far more complex than what is presented, and while it’s true that LaRue hasn’t had any chemotherapy in the relevant timeframe, that does not mean she did not receive conventional treatment, as you will see.

Stefanie LaRue

AFter seeing Leithead’s story, I decided to look into the “cannabis cures cancer” testimonial of Stefanie LaRue. Hers is a sad story in that she was diagnosed at a young age (30 years old) after her boyfriend found a lump in her breast and misdiagnoses by three different doctors. In many ways, her story is an inspiring one based on her will to fight and her activism, which have led her to have served on the Board of Directors for the Los Angeles Susan G. Komen for the Cure, Southern California’s Breast Cancer Network of Strength, and the USC Norris Cancer Center’s Cancer Survivorship Advisory Council. Near and dear to my heart, she also is very much into rescuing and fostering many wounded, mistreated and special needs dogs.

Indeed, I approach this particular testimonial with more than a little trepidation because there’s an incredible amount to admire about LaRue and, more importantly, her involvement with Komen and other breast cancer charities means that people I respect and admire (who might read this) very well might know her—or even be friends with her. Still, given the direction her story has taken, I feel obligated to discuss it.
Here’s a video of her from 2007 when she was still undergoing chemotherapy:
Notice the themes we see so often in cancer patients, particularly young cancer patients: Why me? There must be a reason. It can’t have “just happened”.

Breast cancer is a disease of older women. (Indeed, the mean age at diagnosis is around 61.) There must have been something in the environment. Possibly. As has been discussed before, for breast cancer, environment- and lifestyle-attributable causes account for a much smaller fraction of cancer diagnoses than most people believe, and 1.8% of cases of breast cancer occur in women 34 and under. Given that there are approximately 233,000 new cases of breast cancer diagnosed every year in the U.S., that means that close to 4,200 women under 34 are diagnosed each year with breast cancer. Still, being diagnosed with breast cancer at age 30 is unusual; so it’s understandable that LaRue would wonder why it happened to her.
Worse, LaRue was diagnosed with Stage IV disease, as described in an article by Sonja Renea published on the Medical Jane website entitled “Meet Stefanie LaRue: Cancer Survivor and Medical Marijuana Advocate“:

Stefanie was sent home several times with several rounds of antibiotics, which is quite telling of younger folks being misdiagnosed. By the time she could be tested thoroughly, the cancer had spread to her bones. Doctors diagnosed her with Stage 4 Metastatic Breast Cancer, which is cancer that has spread beyond the breast to other organs in the body. The prognosis was grim: she was given a year to live, at most.
Three weeks later, Stefanie began her first round of chemotherapy. To make matters worse, she had to to [sic] cope with her employer, who showed little sympathy for her situation. Despite her job in commercial real estate being very stressful, she was expected to work through her cancer treatment.

This is a big problem with health care in the U.S. besides the difficulty many people have affording health insurance, a problem only partially alleviated by the Affordable Care Act (a.k.a. Obamacare), which didn’t exist in 2005. You can be diagnosed with metastatic breast cancer and still be screwed as far as work goes. It happens far too often in this country.
So LaRue ended up quitting her job and filing for disability. She underwent six rounds of chemotherapy and then a mastectomy.

At this point reading her story I had a question. If LaRue had bone metastases, it’s not clear to me why her surgeon and oncologist would recommend that she undergo a mastectomy. Three possible reasons suggest themselves to me as a breast surgeon. One is that it was done to prevent the primary tumor from growing through the skin and turning into en cuirasse disease, although usually such surgery is not done right after chemotherapy but when the tumor has started to grow again. Another is that she had a complete radiologic response to the chemotherapy, meaning that all her breast and bone disease disappeared.

When that happens and the patient has been rendered “no evaluable disease” (NED), we will often treat her as though she were not stage IV and undertake surgery with curative intent. The final possibility is that surgery was done with the intent of prolonging survival even though metastases were still present. It’s been an ongoing controversy in breast cancer over whether removing the primary tumor prolongs survival in stage IV disease or whether the apparent improvement in survival due to surgery is due to selection bias; that is, bias towards healthier patients with less aggressive disease who are chosen to undergo surgery preferentially.

More recent evidence suggests that removing the primary probably doesn’t improve survival, but that was not at all clear back in 2005. (To be honest, it still isn’t quite clear.)
On her website, LaRue reports that her tumor was 8 cm in diameter (which is big). Apparently her tumor didn’t shrink enough to be removed in a lumpectomy; so she needed a mastectomy:

After chemo she had surgery to remove the cancer. But her margins were not clear, so another surgery followed. She was left with only skin and a nipple on the right side of her chest. Her breast surgeon had scraped all the way down to the chest wall removing all the breast tissue possible but sparing the skin. Despite the advanced stage of her cancer, she got to keep the outside of her breast because she had a skin-sparing mastectomy. A plastic surgeon was later able to reconstruct her breast, restoring her shape, her femininity and her sexuality.

At this point in my reading, I was unclear as to why a surgeon would do a skin-sparing mastectomy in a patient with stage IV disease. Most plastic surgeons are reluctant to do reconstruction in such a patient because reconstruction can be a big operation, and if the patient isn’t expected to live more than a year it just doesn’t make a lot of sense to have the patient spend a significant chunk of her remaining time recovering from surgery, having additional surgeries to “touch up” the reconstruction.

The willingness of her surgeon and plastic surgeon to undertake a skin sparing mastectomy and reconstruction suggests to me that she had a very good response to the chemotherapy and/or that her prognosis as a stage IV patient was viewed as being considerably more favorable than usual.
Whatever the case, during the chemotherapy that she underwent before her surgery, LaRue looked to alternative medicine to ease her symptoms:

She found help with an integrative oncologist at UCLA, where she learned how to make changes to her diet, use natural supplements, get acupuncture, and work on personal fitness; all of which are integrative, complementary, and alternative treatments to go along with chemotherapy.

Now here’s the thing. As a patient with stage IV disease, LaRue did really well for eight years. It’s hard to find a good detailed description of what happened between November 2005 (when she was diagnosed with breast cancer) and 2013, but she didn’t start using cannabis oil until 2013, which means that conventional oncology is what got her through nearly eight out of the nine and a half years she’s survived with her stage IV cancer.

It’s important to remember that when looking at a lot of the articles about LaRue, because before 2013, although she had gone all in for “integrative oncology,” she hadn’t yet discovered cannabis and was still being treated with mostly conventional medicine. So, between 2006, when she finished her initial treatment, and at least September 2013, when she posted a series of images to Instagram of her hospitalization for thoracoscopic surgery, conventional medicine is what kept LaRue alive.

So when Sonja Renea of the Medical Jane website writes that “Stefanie LaRue was 30 years old when she was diagnosed with Stage 4 Metastatic Breast Cancer and given the dismal prognosis of less than a year to live” and follows it up with, “That was nine years ago,” she is being deceptive.
This is how it’s described in the Medical Jane:

In 2013 Stefanie had a Video-Assisted Thoracoscopic Surgery (VATS) and the results were not good. This was now her third reoccurrence of cancer. The chemo sensitivity testing concluded there were five lines of chemo treatments that would work on the tumors.
Stefanie declined the treatment. “I did my homework. I researched as much as I could. I watched. I listened. I read. I contacted. I prayed. Most of all, I believed. I weighed my options, which were essentially chemotherapy or cannabis oil, and I decided to take the natural route this time…” she says.
Stefanie followed the Rick Simpson Oil (RSO) protocol until she was cancer-free. “Cannabis oil killed all of the tumors in my body. My monthly lab and quarterly scan results are proof that the cannabis oil treatment worked,” she says. Her doctor, who had previously been skeptical, now credits these “alternative” treatments as the reason for her speedy recovery.

On Instagram, LaRue described it thusly in a posting dated October 2, 2013:

Dear cancer, as we both know, yesterday was a big day of news. And sadly for you, you lost. You lost your “upper hand” you tried to claim in that you were potentially showing up again (unwelcomed in my body) not as a metastatic reoccurrence, but as a possible new primary cancer. Which would have been a much more challenging ass kickin match between you and I. None the less, I would have enjoyed. But since you are now known as the same initial metastatic breast cancer reoccurring, I hope you are preparing for what is coming to you.

Because now I have the upper hand. When the chemo sensitivity tests are complete on my biopsy tissue at Caris Labs we will know exactly what to come after you and all your little friends with! Poor you. I know your still cowardly hiding in my body but you have pissed off some pretty important people that care a lot about me and guess what… Now they too are coming in to whip your ass!!!

We’ve encountered Caris Labs before in the context of discussing Stanislaw Burzynski’s incompetent “personalized gene-targeted cancer therapy.” Basically, Caris is a company that will do various genomic tests and immunohistochemistry on a tumor sample to try to identify which targeted agents it might be sensitive to. I’ve basically discussed how the routine use of such a test is premature, given that there isn’t any good evidence that using a test like the one from Caris or other competing tests results in better response rates or prolonged survival, but such tests have still proliferated and their use is not uncommon, even in academic medical centers.

In any case, at this point in the fall of 2013, LaRue was facing her third recurrence of cancer. Unfortunately, this is a story very much like the many alternative cancer cure testimonials I’ve deconstructed over the years in that we lack a lot of key information, which means that I can only speculate. First, we don’t know how extensive a cancer recurrence LaRue had. Given that she underwent thoracoscopic lung surgery (a thoracoscope is like a laparoscope, except that instead of letting a surgeon operate in the abdomen it allows the thoracic surgeon to operate in the chest with minimal incisions), presumably she had a lung nodule.

In a patient with stage IV disease, most such lesions would be biopsied using a core needle under CT scan guidance, rather than excised surgically through a laparoscope. Why did the surgeon choose this course?
A couple of possible reasons suggest themselves from the story. First, perhaps she did undergo a CT-guided core needle biopsy and the diagnosis was uncertain. Certainly LaRue’s Instagram posting, in which she gloats over her tumor for not being a new primary tumor but just the same as the other recurrences of her original tumor, suggests that this could be the case.

After all, a new suspicious lung nodule in a breast cancer patient is usually considered a new metastasis until proven otherwise. In any case, in patients with metastatic disease, a tissue diagnosis is always imperative before beginning treatment if at all feasible. Another possibility is that this tumor, whatever doctors thought it was before surgery, was the only site of disease detectable. In such a case, particularly in a young patient who had been doing well for nearly eight years even if she did have stage IV disease, strong consideration would be given for excising the cancer and eliminating the only known site of disease even though the evidence that metastasectomy (removing the metastasis) will prolong survival in breast cancer is mostly without controls and thus prone to selection bias.

(Metastasectomy of liver and lung metastases can definitely prolong survival in colorectal cancer.) Still, there is evidence that in select patients removing pulmonary metastases can result in significant survival benefit. Whether LaRue is one of those select patients is unclear.
So here’s what I think probably happened. After surgery LaRue (understandably) did not want to undergo further chemotherapy. For whatever reason, she latched on to Rick Simpson’s hemp oil as the treatment that would control her cancer.

How she found out about it and why she became convinced it would cure her, it’s hard to say from publicly available information. In the Medical Jane story, LaRue proclaims that “cannabis oil killed all the tumors in my body” and that her “monthly lab and quarterly scan results are proof that the cannabis oil treatment worked.” It is, of course, impossible to confirm or dispute this assessment without knowing what all her scans showed.

There is, however, a photo on Instagram of LaRue receiving a shot, which she identifies as Xgeva, which LaRue described as “bone mets maintenance.” And so it is. It’s a monoclonal antibody against the RANK ligand, a protein that acts as the primary signal for bone removal, and it prevents fractures in patients with bone metastases. So this implies that LaRue still has bone metastases. It also makes one wonder what other non-chemotherapy conventional therapy she might be taking. There’s also a post by her on Twitter asking about Afinitor (everolimus):

Afinitor is a drug that inhibits an enzyme called mTOR and is used in cancer that is positive for the estrogen receptor after it develops resistance to anti-estrogen therapy. Apparently she did not take Afinitor, because on March 14, 2014 LaRue posted a photo on Twitter:

In the photo, LaRue is receiving an injection of Zoladex (goserelin), a drug used to suppress production of sex hormones. In other words, six months after her thoracoscopy, LaRue was receiving conventional medical therapy, specifically a treatment to shut down her ovaries’ production of estrogen.

Thus, LaRue appears to be the case of a cancer patient who chose unproven alternative medicine but at the same time continued to receive conventional medical therapy for her cancer and did very well. As is the case with most such patients, she attributes her excellent outcome, at least after her most recent relapse, far more to the alternative treatments (in this case, Rick Simpson’s hemp oil) than she does to the conventional therapy she is also taking, even after her discovery of hemp oil.

I also can’t help but point out that the very fact that LaRue survived nearly eight years with stage IV cancer before discovering hemp oil is a pretty strong argument that from a biological standpoint her tumor is pretty indolent, as some tumors positive for the estrogen receptor are; so it’s not surprising that she would still be alive a year and a half after her thoracoscopy on Zoladex and Xgeva alone (plus whatever other conventional medical therapy she is receiving). Only LaRue and her oncologist know for sure, though, and her oncologist can’t tell anyone without her permission.

Finally, there’s the claim that LaRue is now cancer-free, without having undergone chemotherapy this time around, a claim repeated in Leithead’s credulous interview. There’s even a brief scene showning a radiology report, which, if you freeze frame, indicates that there are still lesions in her spine that could be consistent with healing metastases, but there are no new ones. What does this mean? Who knows? Without her full clinical history and full knowledge of what she is taking in addition to the cannabis, it’s impossible to tell.

Cannabis versus breast cancer

As much as I admire the grace and determination with which Stefanie LaRue has endured over 9 years after her cancer diagnosis, as a cancer doctor it bothers me profoundly that she has allowed herself to fall under the spell of the “cannabis cures cancer” alternative medicine crowd, in particular Rick Simpson. I discussed Simpson the last time I wrote about cannabis and cancer. As I said at the time, Rick Simpson is just like cancer quacks the world over, who have no firm evidence to back up their miraculous-sounding cure rates and excuse their failures by blaming the treatment patients had before they started the quackery.

Quacks like Rick Simpson do those who think that cannabinoids have promise in treating cancer no favors.
I also discussed how the vast majority of studies touted by the “cannabis cures cancer” advocates tend to be preclinical studies in cell culture or animal models that show relatively modest antitumor effects due to various cannabinoids. Indeed, this article on Medical Jane, “Studies Show Cannabinoids May Help Fight Triple-Negative Breast Cancer“, fails to provide particularly convincing evidence that they do.

Before I look at the studies, I can’t help but note that triple negative breast cancer is breast cancer that makes neither the estrogen receptor (ER), the progesterone receptor (PR), nor overexpressed HER2. Yet the article invokes Stefanie LaRue, who clearly has ER(+) breast cancer.
Another thing that needs to be pointed out. Every single one of the studies invoked by Medical Jane has nothing to do with hemp oil, be it Rick Simpson’s hemp oil or some other type.

Each of the studies examines either purified cannabinoids or, in the case of this study, a chemically modified cannabinoid. This study cited in Molecular Cancer, for instance, looks Δ9-tetrahydrocannabinol, the most abundant and potent cannabinoid in marijuana, and JWH-133, a non-psychotropic CB2 receptor-selective agonist. Both inhibit the growth of HER2(+) breast cancer cells in cell culture and in mice, but the concentrations needed are pretty high, with an IC50 (concentration that is 50% of maximum inhibition) in the range of 5 to 10 μM, concentrations achievable with injection of purified compound but certainly not by smoking pot

You are also unlikely to achieve these levels by drinking hemp oil, which, by the way, usually contains so little THC that it is below the limit of detection for common assays and manufacturers brag that it’s impossible to fail a drug test if you’re consuming hemp seed oil because “THC levels in our products are barely measurable.” Of course, I do realize that Rick Simpson calls his oil hemp oil even though it’s really cannabis oil derived from the buds rather than the seeds, but even he brags that “following the dosage previously described, many people can take the full treatment and never get high,” which implies that his oil achieves nowhere near the concentration of THC in the blood necessary to be active against cancer.

Moreover, oral bioavailability of THC from such oils is notoriously low, between 4-20%, making it unlikely that concentrations well above the 10 μM necessary to inhibit or kill more than 50% of the cancer cells are achievable with oral dosing.
Thus, the various studies cited, such as this one, which shows inhibition of the epidermal growth factor pathway by purified cannabidiol (CBD), a non-psychotropic cannabinoid; this one, the aforementioned study that examines purified Δ⁹-THC and JWH-133 against HER2(+) breast cancer; and this one, which also examines CBD in breast cancer, are interesting and very preliminary.

Moreover, they all examine cannabinoids purified from cannabis, and one even examines a chemically modified cannabinoid. In other words, even if cannabinoids make the jump from preclinical models to humans, these studies do not support the use of medical marijuana, either smoked as the plant or ingested as an oil, to treat breast cancer. They also do not suggest sufficient activity to produce miracle cures of stage IV cancer as described by Rick Simpson.

Indeed, a recent review concludes that “current preclinical data does not yet provide robust evidence that systemically administered Δ⁹-THC will be useful for the curative treatment of cancer,” although CBD might have a role based on preclinical data.
Neither cannabinoid, however, is likely to be curative for advanced cancer. It’s possible that specific cannabinoids might have a role to play in the multimodality treatment of cancer, but, given what we know about them from preclinical studies, it’s highly unlikely that cannabinoids, medical marijuana, or Rick Simpson’s hemp oil can cure stage IV cancer of any kind.

Hope versus hype

I have no doubt that Stefanie LaRue honestly believes that Rick Simpson’s hemp oil is the reason why she’s still alive today and doing so well. I can’t help but point out that Stanislaw Burzynski’s patients, for example, also honestly believe that his antineoplastons are what saved their lives, even though even Burzynski can’t produce good evidence that they have antitumor activity. Depressingly, it just goes to show how even such an accomplished woman can fall prey to the same human cognitive shortcomings that we all share and confuse correlation with causation.

If it were just her, I wouldn’t have felt obligated to write this post, but LaRue makes it very clear that not only does she believe that Rick Simpson’s hemp oil allowed her to heal herself of her longstanding metastatic cancer:

But she plans on becoming an evangelist for Rick Simpson’s hemp oil and medical marijuana:
In this video she notes that she’s had multiple recurrences and they’re all gone, after which she challenges the viewer to “explain that.” Believe it or not, personally, I’d be overjoyed if something as simple as hemp oil could treat stage IV cancer so effectively. I really would, as it would mean that I’d rarely have to see a breast cancer patient die.

However, although I can’t be sure without a lot more information (which is highly unlikely to be forthcoming) and I do have to concede the possibility, albeit remote, that Rick Simpson’s hemp oil is the reason why LaRue has survived a year and a half since her last new metastasis, I nonetheless suspect that it is far more likely than not that it is the Zoladex and the Xgeva (not to mention whatever other conventional treatments that LaRue may be taking that she hasn’t mentioned on social media) that are keeping her going now, combined with her disease’s already-demonstrated indolent biology.

And long may they continue to do so!
For nearly eight years, Stefanie LaRue fought a battle with courage, inspiring intelligence, and grace. Her story was (and still is) a story of hope for women with stage IV cancer that they can live a long time with the disease with good quality of life. Unfortunately, a year and a half ago her story took a turn into pseudoscience, becoming a cautionary tale of how even the most intelligent, ambitious, and determined person can be subject to magical thinking.

This would not be an issue with me were it not that, inadvertently, and with the best of intentions, LaRue has declared her determination to promote Rick Simpson’s hemp oil as a cancer cure, using her own story as an example of what it can do. Given her proven history of advocacy and her numerous accomplishments with organizations like the Komen Los Angeles County Affiliate from 2008 to 2010 (before she discovered hemp oil), I can’t help but be worried that she will in her quest to save women from stage IV breast cancer end up doing exactly the opposite for some women.

I still hold out hope that, given her history, LaRue will eventually realize that her true story is far more a cause for hope for women with stage IV disease than her current belief that cannabis is what has kept her alive.. Thanks to advances in breast cancer care, more and more women with stage IV disease are living a lot longer than expected, even ten years, all with no need to resort to unproven treatments promoted with testimonials, like Rick Simpson’s hemp oil.
That’s the real reason for hope.

Report: Racial disparities in drug arrests persist after Colorado legalizes marijuana

By KRISTEN WYATT

DENVER (AP) -- The legalization of marijuana in Colorado hasn't solved the racial disparities in enforcement that drug-policy reformers had hoped to end, with blacks still far more likely than whites to be charged with pot-related crimes, a new report says.

The report, issued Wednesday by the pro-legalization Drug Policy Alliance, showed that marijuana arrests in Colorado all but stopped after voters made the drug legal in small amounts for those 21 and older.

But the report noted continuing racial disparities involving the marijuana crimes that remain, including public use and possession in excess of the one-ounce limit.

The study examined drug arrests in all 64 Colorado counties for two years before and two years after legalization in 2012.

The total number of charges for pot possession, distribution and cultivation plummeted almost 95 percent, from about 39,000 in 2010 to just over 2,000 last year.

Even after legalization, blacks were more than twice as likely as whites to be charged with public use of marijuana. Blacks were also much more likely to be charged with illegal cultivation of pot or possession of more than an ounce.

"Legalization is no panacea for the longtime issues that law enforcement had with the black and brown community," said Art Way, Colorado director for the Drug Policy Alliance.

Still, the drop-off in overall arrests is good news for minorities, said Tony Newman, also of the Drug Policy Alliance.

"Despite the unsurprising racial disparities, these massive drops in arrests have been enormously beneficial to people of color," Newman said.

The analysis did not break out data for Colorado's largest ethnic minority, Latinos. That's because data comes from the National Incident-Based Reporting System, which does not tally numbers for Latinos.

The region's top law officer for coordinating drug enforcement, Tom Gorman of the Rocky Mountain High Intensity Drug Trafficking Area program, insisted that officers are not racially profiling pot users.

"Racial disparities exist in other laws. What does that mean, that homicide law, rape laws, weapon laws are racist? There are other factors going on here that we need to address," Gorman said.

After legalization, racial disparities did ease somewhat for marijuana distribution charges. Blacks accounted for about 22 percent of such arrests in 2010 and around 18 percent in 2014.

The arrest data got a mixed response from the regional head of the NAACP.

"The overall decrease in arrests, charges and cases is enormously beneficial to communities of color who bore the brunt of marijuana prohibition," Rosemary Harris Lytle said in a statement.

"However, we are concerned with the rise in disparity for the charge of public consumption and challenge law enforcement to ensure this reality is not discriminatory in any manner."

In 2014, the year Colorado's recreational marijuana stores opened, blacks were 3.9 percent of the population but accounted for 9.2 percent of pot possession arrests.

For illegal marijuana cultivation, the disparities didn't just persist. They got much worse.

In 2010, whites in Colorado were slightly more likely than blacks to be arrested for growing pot. After legalization, the arrest rate for whites dropped dramatically but ticked up for blacks. In 2014, the arrest rate for blacks was roughly 2.5 times higher.

The Drug Policy Alliance did not conduct a similar analysis in Washington state, which also legalized pot in 2012. But racial disparities appear to have persisted there, too.

Last September, Seattle's elected prosecutor dropped all tickets issued for the public use of marijuana through the first seven months of 2014 because most of them were written by a single police officer who disagreed with the legal pot law.

About one-third of those tickets were issued to blacks, who make up about 8 percent of Seattle's population.

A researcher who did not work on the Drug Policy Alliance report, sociologist Pamela E. Oliver of the University of Wisconsin, said the numbers reflect greater law enforcement attention paid to blacks.

"Black communities, and black people in predominantly white communities, tend to be generally under higher levels of surveillance than whites and white communities," she said in an email, "and this is probably why these disparities are arising."

Bill to legalize medical marijuana introduced in the House

 ByJake Miller
A bipartisan effort to legalize medical marijuana at the federal level is now underway in both Houses of Congress, and its sponsors acknowledge they face an uphill climb to passage - but they believe the public is on their side.
"Polls show that at least 86 percent of Americans say medical marijuana should be available," said Rep. Steve Cohen, D-Tennessee, in an interview with CBS News. "Legislators rarely lead, they generally follow. I guess it's called cultural lag...Eventually, people in Congress start catching up."

Cohen and Rep. Don Young, R-Alaska, unveiled a bill on Tuesday that would reclassify marijuana as a Schedule II narcotic, recognizing some appropriate medical uses for the drug. Marijuana is legal for medical use in 23 states and the District of Columbia, but the federal government currently classifies pot as a Schedule I narcotic with no apparent medical utility.
The reclassification would have a variety of effects on how the federal government enforces marijuana laws.

It would allow states to set their own medical marijuana statutes free of federal interference, allow medical marijuana dispensaries to access the banking system, and allow doctors at government agencies like the Department of Veterans Affairs to prescribe medical marijuana in states where it's permitted. It could also jumpstart research into the drug's medical uses.
The bill is the House version of the Senate's Compassionate Access, Research Expansion, and Respect States (CARERS) Act, which was introduced earlier this month by Sens. Kirsten Gillibrand, D-New York, Cory Booker, D-New Jersey, and Rand Paul, R-Kentucky.

Supporters have framed the bill as a common-sense way to bring real relief to suffering people. Cohen cited alternative forms of the drug like cannabidiol (CBD), a marijuana derivative that has no psychoactive effects but has been shown to provide relief to children with seizures.
That treatment isn't available to people in states that prohibit medical marijuana, and "it's cruel and it's heartless," said Cohen, citing the experience of a 3-year-old Tennessee girl, Chloe Grauer, who died last year of a rare neurological disorder after she was denied access to CBD. "People are waking up to the fact that we ought to use whatever we have to help people when they're sick."

The congressman reserved particularly harsh criticism for the fact that VA doctors aren't allowed to prescribe medical marijuana to veterans with post-traumatic stress disorder and other maladies.
" VA Doctors should not be muzzled," he said. "The idea that veterans who go to war and see life squashed out can't talk to doctors about marijuana is absurd. It's crazy."

The effort has even drawn some support from the GOP, which has traditionally taken a harder line on drug laws. "The topic of medical and recreational marijuana has always been an issue of state' rights for me," Young, the Alaska Republican, said in a press release on Tuesday. "My position aims to reaffirm the states' rights to determine the nature of criminal activity within their own jurisdictions, which I believe is critical for states to effectively legislate within their borders."

Cohen credited the veterans' health care angle for drawing GOP attention to the issue, and he said Young, a "respected veteran legislator," may give more Republicans a "little bit of courage" and persuade them to sign on. He acknowledged that a rising strain of libertarianism in today's GOP, particularly among lawmakers from Western states, may also boost the measure's support.
In addition to Young, Cohen said, Rep. Dana Rohrabacher, R-California, has agreed to sponsor the measure. He also said he'd talked to two additional Republicans on Tuesday who appeared ready to join the fight.

Some Democrats, like Sen. Dianne Feinstein, D-California, have voiced concerns about the increased potency of modern marijuana, saying they'd like to see more research into the non-psychoactive forms of the drug.
Cohen has little patience for that particular reservation. "It's just horse manure to talk about potent versus less potent," he said. "If you make it legal, people might know the potency of what they're buying."

Despite some signs of momentum, the bill faces an tough road to passage in a GOP-controlled Congress. Asked whether House Speaker John Boehner would schedule a vote on the bill if it receives enough support, Cohen said, "I doubt it." Even moving the bill through the House Judiciary Committee, which holds jurisdiction over the issue, would be "tough," he said.
But the congressman argued that the bill's eventual success is guaranteed, given the generational shift toward more permissive attitudes on pot laws.
"One day, there will be passage," he said. "The times, they are a-changin'."

Why a Closely Watched Marijuana Case in Federal Court Looks to Be Leaning in the Right Direction

Does marijuana deserve to be Schedule I?
By Jeremy Daw
Judge Kimberly Mueller, the federal magistrate who made history by granting defense requests for a five-day hearing on the constitutionality of the continued inclusion of cannabis in Schedule I of the Controlled Substances Act, was originally scheduled to meet with the parties of US v Schweder et al for a status hearing this week — but has delayed that meeting until April 15th.

The latest delay represents the continuance of a pattern. Previously Judge Mueller agreed to a defense request for extended written arguments on the case, and now this is the second time she has delayed a hearing on her own motion pending her ruling on the question.
Obviously, she needs more time. But what can the delay mean for the fate of the defendants accused of trafficking in a Schedule I drug?

While the shoals of predicting the actions of federal judges are littered with the hulls of many a journalist’s career (remember the ObamaCare decision?), nevertheless I feel sufficiently bold on this question to float out some educated guesses:
She will rule on the merits.
In their final written arguments, prosecutors pressed for an essentially procedural decision which would have eliminated the question on the basis of the esoteric doctrine of standing.

At the time, I thought that the standing argument was the strongest one prosecutors had, mainly by virtue of the fact that arguing the case on the merits was so difficult for them — who could persuasively argue, in the weight of all the accumulated evidence, that cannabis actually belongs in Schedule I, meaning that it has no recognized medical value and cannot be safely administered even under a doctor’s supervision? The standing argument was much stronger, given that it allowed the US Attorneys to sidestep this issue.

Based on Mueller’s comments from the bench, combined with the pattern of delays in constructing her legal theory of the case, it appears unlikely that this judge will dispose of this question on purely procedural grounds. On the final day of oral argument in the case, for example, Judge Mueller posed a hypothetical to the attorneys in the case. “Suppose I reach a decision on the merits,” she said, “using either the rational basis standard or what one judge has called ‘rational basis with bite.'” It’s one of the only clues of her intent from an otherwise poker-faced judge.

The repeated delays in the written argument phase — three now — also favor a decision on the merits. While written opinions on standing can be as arcane as any other topic of law (if not more so), the area of law applying standing to drug law cases is relatively well-developed compared to the novel — indeed, historic — question posed by the merits: is keeping cannabis in Schedule I so out of step with reality as to be unconstitutional?

Finally, judicial economy must be considered. The dockets of federal judges are famously crowded; it makes little sense to devote five days of extremely valuable court time to establishing evidence relevant to the merits of the case if one didn’t intend to decide the case on the merits.
She’s expecting an appeal.
When another federal judge in California, Vaughn Walker, ruled the state’s newly-passed Proposition 8 unconstitutional — thereby opening the door for gay marriage throughout the state — he knew that he was tackling a number of controversial issues, from the legal definition of marriage to principles of judicial activism.

An appeal to the 9th Circuit was all but assured; therefore Judge Walker wrote an extensive 136-page opinion which exhaustively covered every conceivable point of fact and law. The effect was favorable, from Judge Walker’s point of view: the 9th Circuit took up the full case without remand or procedural delay, finding his tightly-argued opinion credible. Eventually the Supreme Court of the United States gave their own stamp of approval, allowing the 9th Circuit decision to stand without modification. Home run.

I am by no means the first commentator to compare the national issues of medical marijuana and gay marriage. Both have proven remarkable exceptions to the political impasses which have plagued the national scene for nearly a decade; in the case of gay marriage, when elected representatives moved too slowly to respect rapidly shifting public opinion, the judicial bench led the nation into reform.

Repeated delays in crafting her ruling therefore probably indicate an expectation on Judge Mueller’s part to have her decision subjected to the scrutiny of the 9th Circuit — and possibly the US Supreme Court as well. And that *probably* means…
She will find Schedule I unconstitutional.
An appeal is more likely to come from the US Attorney than from the defense in this case. While defense attorneys Zenia Gilg and Heather Burke are certainly capable of tackling a long game through the federal court system, the cost-benefit analysis of appeal favors the prosecution, as Judge Mueller well knows.

Whereas the considerable cost of an appeal would have to be financed privately for the defense, the federal Department of Justice has a practically unlimited bank account to draw against (and no — the Rohrabacher-Farr Amendment to the 2015 spending bill does not affect the government’s prosecution budget in this case even one whit). Therefore, prosecutors have a powerful advantage against the accused in the appeals phase; they can grossly outspend them.

But there’s an even more compelling reason to expect a ruling for the defense from Judge Mueller: the federal judiciary, after all, is sensitive to the political winds of public opinion. Chief Justice John Roberts may have famously analogized his job to an umpire “call[ing] balls and strikes,” but legal historians know differently. Judge Walker, for one example, did not decide to overturn a gay marriage ban in a vacuum; rather, with an impeccable sense of political timing, he issued his ruling right at the moment when public opinion was shifting decisively toward allowing gay marriages to go forward. As a result, he was able to influence the national conversation even as he responded to it.

An even more salient example can be found at the dawn of the federal drug war, around a century ago. The 1914 Harrison Act is often remembered as the federal law which first criminalized drugs like heroin and cocaine (though not cannabis), but in reality it didn’t happen exactly that way. In fact, the Harrison Act resembled many of the medical marijuana statutes which have been passed in the last two decades, in that it required that heroin and cocaine could only be dispensed with a prescription and provided other limits on their distribution.

As late as 1916, the US Supreme Court enforced this interpretation of the Harrison Act, unequivocally ruling that medical heroin and cocaine were still allowed with a doctor’s prescription — as noted by David Musto in his outstanding drug policy history The American Disease. But then, only three years later the Court did a complete about face, ruling in US v Doremus et al (1919) that the Harrison Act required doctors to wean their patients off such drugs, even if doing so would cause immense suffering for the patient. What had happened to completely reverse Court jurisprudence in only three short years? The answer, according to Musto, was a rapid shift in public opinion.

That is precisely the situation faced by Judge Walker in 2010 on the issue of gay marriage, and faced now by Judge Mueller on the question of cannabis policy. While well-respected polls now show that a majority of Americans favor the legalization of cannabis for all adult uses, the demand for medical marijuana reform is even starker, with up to 80% of US voters demanding that US policy recognize the “drug” as what it really is: a medicine.

A ruling for the defense on this motion would be in step with 80% of Americans; while her decision will make no statement about which of the other four schedules cannabis should belong to, it will unequivocally state that Schedule I is wrong. Few Americans indeed would disagree with that.
What will happen after?
If my prediction is correct and Judge Mueller rules for the defense on the merits, the prosecutors can be expected to immediately move for an appeal and a temporary stay on her ruling until the matter can be heard by the 9th Circuit. Such a move could easily delay any ruling from taking effect until next year.

In the unlikely event that such a motion isn’t granted, then the administrator of the DEA can be expected to immediately schedule cannabis in Schedule II — which happens to be one of the moves contemplated by the CARERS bill just filed in the US Senate.
Thus, a favorable ruling by Judge Mueller will not by itself end the federal war on marijuana. Cocaine is listed in Schedule II, but any would-be Tony Montana in the US still has to worry about DEA raids.

Nevertheless, it would still be a huge win. Just as Judge Walker’s Prop 8 decision had a massive effect on the national politics of gay marriage, so too could a favorable ruling by Judge Mueller finally begin to budge an intransigent Congress into finally respecting the will of the people who voted them in office. Passing the CARERS bill would be a cinch.

A glimmer of hope

Family hopeful as medical marijuana bill heads to Senate floor
By Melanie Ruberti
What looked like a bleak outcome for the medical marijuana proposal, HB 1, as it passed from the Georgia House of Representatives to the Senate, became a little more hopeful on Thursday for families and legislators still fighting for the bill.

Dale Jackson believes it was a miracle.

Jackson, whose 7-year-old son, Colin, is autistic, testified before a Senate committee on Thursday about the benefits of cannabis oil and how it would potentially help thousands of people suffering from a variety of diseases.

Jackson said he was prepared for the worst, but was shocked at how the Senate session unfolded.

“It was an unbelievable day, compared to what we were expecting last week,” he said. “Technically, HB 1 no longer exists. Senator Renee Unterman presented a substitute for HB 1 and Senate Bill 185, which dealt with clinical trials for cannabis oil … and combined the two together.”

According to Jackson, the rumors of the Senate Health and Human Services Committee totally gutting the bill, which passed the House, proved to be false. Minor changes were made to the bill, including pairing down the list of diseases and disorders allowed to use medicinal marijuana from nine to eight. Fibromyalgia was cut from the list.

The Senate committee, chaired by Renee Unterman, R-Buford, still wouldn’t add autism back on to the bill. Jackson said he spoke with her about it on Thursday.

“In my world, I can appreciate her honesty. Her reason was 30 percent to 40 percent of autism patients have had seizures in their life time. So, in a way, autism is still covered,” Jackson said.

However, the diagnosis would not apply to his son Colin, who stopped suffering seizures when he was 3 years old. He is a low functioning and, according to Jackson, is starting to show signs of a “tic” where he bangs his head on things. Colin also can’t feed himself or communicate with his parents.

“He has one language, and it’s outbursts, and that’s if he’s angry or happy,” said Jackson. “It makes it difficult because we (family) know he’s trying to communicate with us.”

Jackson said he plans on petitioning other senators, including Josh McKoon, R-Columbus, to add autism back on the list as an amendment to the bill.

“I made a commitment to my son that I would speak on his behalf,” said Jackson. “So every chance I got, I did. And I’m not going anywhere … I’m still going to be there for all the families battling autism.”

“In everything I’ve done legislatively … and everyone knows this … I’m generally not happy with compromise. I’m more of a ‘Let’s go for what we know is right principally. No compromises.’ But with this, at the end of the day, if the only thing that passed was for seizures, I would be happy. Many people died because it got caught up in the legislative session last year. And we were determined this year, not to let that happen … we’re not talking about taxes, we’re talking about people’s lives.”

Jackson said he is confident the new version of HB 1 / SB 185 will pass the senate and be signed by Georgia Gov. Nathan Deal into legislation this year – whether or not his petition for an amendment is added to the bill.

“Anything could happen on the Senate floor,” Jackson said. “But just the fact that they (Senate committee) kept most of HB 1 intact … it says a lot about the support we’ve gotten around the state. Legislators have been getting hundreds of phone calls every day. So compared to where we were a month ago … this truly is a miracle.

“It would be a massive shock to everything I know about the Georgia legislative process if the bill did not pass as is, right now, by the legislature and signed by the Governor.”

The new version of the bill went to the Senate Rules committee Friday afternoon. Jackson believes it will hit the Senate floor for a vote either today or Tuesday. Jackson planned on being at the capitol both days to watch the vote.

  

Feds spend $4.3 million on medicinal marijuana for vets

The cost of providing medical marijuana to the country’s injured soldiers under a Veterans Affairs program jumped to more than $4.3 million this fiscal year, an increase of 10 times what was spent last year.
And the number of ex-soldiers eligible for taxpayer-funded, prescribed pot more than quadrupled to 601 patients, according to figures released by the department.

The numbers represent a dramatic escalation, even from last fall, when former veterans minister Julian Fantino was told in a briefing note that there were 224 approved cases.
At the beginning of the last budget year there were 116 eligible veterans.
In 2013-14, the government spent $417,000 on medical marijuana for soldiers, said the briefing obtained by The Canadian Press under access to information legislation.

The jaw-dropping increases may represent a conundrum for Health Canada, which routinely warns against marijuana use, and the ruling Conservatives who have ridiculed Liberal Leader Justin Trudeau’s campaign for overall legalization of marijuana.
In a statement, a Veterans Affairs spokeswoman stood by the program, pointing to government documents explaining that even though the government does not want to see marijuana used as medicine, the courts have ordered patients to have access to it if prescribed.

“Marijuana for medical purposes is not an approved drug or medicine in Canada and Health Canada does not endorse or promote the use of marijuana,” said Janice Summerby in an email. “However, (Veterans Affairs) will support eligible veterans by reimbursing the cost of marijuana for medical purposes if their physician deems it is an appropriate treatment for the veteran’s health condition and authorizes its use in accordance with Health Canada’s regulations.”

Throughout much of last year, there was a growing debate within the veterans department about how much would be covered by the program, introduced in 2008, and whether it should be capped or even cancelled outright.
Fantino, who has since been replaced by Erin O’Toole as minister, was presented with four different options, including dropping the policy, but retaining existing clients; or eliminating it altogether.

In a pamphlet sent to constituents last year, Fantino claimed Trudeau wants to “make buying marijuana a normal, everyday activity for young Canadians” and even charged that the Liberal leader wants to allow the sale of pot in corner stores.
At the same time, Health Canada — which oversees the country’s burgeoning medical marijuana industry — is running ads saying: “The science is clear. Marijuana use equals health risks.”

Clayton Goodwin, a former reservist who was injured in the Far North in 2004, said the mixed messages make it hard to get pot prescribed by a doctor, even though medical marijuana has been legal since 2001.
“The personal stigma and shaming of an individual’s choice of medicine is something that needs to be addressed,” said Goodwin, who noted that a group run by an ex-combat engineer in New Brunswick — Veterans Helping Veterans: Marijuana for Trauma Inc. — is helping pair veterans with doctors who will prescribe marijuana.

He said many veterans with chronic pain, anxiety and post-traumatic stress are choosing medicinal pot over pharmaceuticals for safety and to get away from some of the side effects of prescription drugs.
Goodwin agreed that the price of anywhere between $9 and $15 per gram was too high, but blamed the government.
“Right now, normal Canadians, never mind veterans, do not have enough access from the licensed producers from the program that’s been put in place to supply us our medication because (the government) hasn’t licensed enough of them and they are taking on too many consumers,” Goodwin said.

Cancelling or capping the program, especially in an election year, could further anger an already incensed veterans community.
The debate at Veteran Affairs started in earnest last spring after Health Canada introduced regulatory changes that limited its role to overseeing the rules and licensing of private producers.
“There are no longer any health criteria to be met and fewer controls over who can prescribe,” said the Oct. 20, 2014 briefing note to Fantino.

“New regulations do not speak to quantity limits or pricing of marijuana.”
Before the change, Health Canada provided eligible veterans with marijuana at a fixed price of $5 per gram, but private growers can now charge what the market will stand.
Health Canada guidelines suggest individuals should limit their consumption to five grams per day, while the College of Family Physicians of Canada suggests three grams.
Right now, eligible veterans can receive up to 10 grams of pot per day. Requests for higher amounts are reviewed on an individual basis by department bureaucrats as long as a doctor provides a written rationale.