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Trump Opioid Panel Will Recommend Nationwide Drug Courts, Tightened Prescribing Rules

Wed, 11/01/2017 - 08:17
The draft proposal is definitely a mixed bag.

 

 

Trump opioid panel will recommend nationwide drug courts, tightened requirements for prescribers

WASHINGTON - President Trump's commission on combating the opioid epidemic plans to encourage the federal government to establish drug courts in every federal judicial district, adjust reimbursement ...

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Here Is Why Congress Believes Marijuana Is the Same as Heroin and Meth

Wed, 11/01/2017 - 08:06
This ridiculous idea is the fault of the Controlled Substances Act, but why is Congress trying to dupe the public?

Earlier this week, Congressman Tom Garrett, a Republican freshman from Virginia, introduced legislation aimed at federally decriminalizing marijuana. The bill — “Ending Federal Marijuana Prohibition Act of 2017” — would take marijuana off the federal controlled substances list,  joining other industries such as alcohol and tobacco instead of heroin and meth.

“I have long believed justice that isn’t blind, isn’t justice. Statistics indicate that minor narcotics crimes disproportionately hurt areas of lower socio-economic status and what I find most troubling is that we continue to keep laws on the books that we do not enforce,” Garrett said in a statement.

Hawaii Congresswoman Tulsi Gabbard is the lead co-sponsor on this bipartisan bill.

The proposed legislation is identical to the bill introduced in 2015 by Sen. Bernie Sanders, which failed to even get a hearing.

Before we get into why Garrett proposed the legislation, it’s worth reviewing the basics of the Controlled Substances Act of 1970 and why marijuana is classified as a Schedule I drug — the highest tier that includes heroin. According to the federal government, Schedule I drugs have a “high potential for abuse” and “no medically accepted use.”

Here is what you need to know about the CSA and the scheduling of marijuana:

How Did This Happen?

It all started in 1970. Congress passed the Controlled Substance Act, which was immediately signed by President Richard Nixon, who felt strongly that marijuana use was tearing the fabric of the nation. He associated marijuana users with hippies and anti-war protesters. The act established five schedules — or categories — by which all drugs would be classified.

The inclusion of cannabis as Schedule I was supposed to be temporary, subject to review by a commission that would recommend a categorization based on science.

Two years later, the blue-ribbon commission’s recommendation was in. The National Commission on Marihuana and Drug Abuse issued two substantial reports: Marihuana: A Signal In Misunderstanding and Drug Use in America: Problem in Perspective.

The commission concluded that marijuana was not a serious threat to public health and recommended changes to the scheduling. In fact, the so-called Shafer Commission — named after the Raymond Shafer, the chairman of the panel and former Pennsylvania governor — recommended that small amounts of cannabis should be legal to possess. The report stated:

“The criminal law is too harsh a tool to apply to personal possession even in the effort to discourage use.  It implies an overwhelming indictment of the behavior which we believe is not appropriate. The actual and potential harm of use of the drug is not great enough to justify intrusion by the criminal law into private behavior, a step which our society takes only with the greatest reluctance. … Therefore, the Commission recommends … [that the] possession of marijuana for personal use no longer be an offense.”

Nixon, who hand-picked all 13 members of the Shafer Commission, ignored its recommendation.

Side note: Cocaine and methamphetamine, opium and other clearly more dangerous drugs fall under Schedule II.

What About Medical Marijuana?

Yes, what about the medicinal use of an herb that the federal government states no medically accepted use.” Twenty-eight states disagree and have passed legislation that allows for the medical marijuana programs.

Even more head-scratching is this: In 2003, the U.S. Department of Health and Human Services received U.S. Patent No. 6,630,507. The patent clearly states that the compounds found in cannabis act as antioxidants and neuroprotectants. The patent summary states:

Cannabinoids have been found to have antioxidant properties, unrelated to NMDA receptor antagonism. This new found property makes cannabinoids useful in the treatment and prophylaxis of wide variety of oxidation associated diseases, such as ischemic, age-related, inflammatory and autoimmune diseases. The cannabinoids are found to have particular application as neuroprotectants, for example in limiting neurological damage following ischemic insults, such as stroke and trauma, or in the treatment of neurodegenerative diseases, such as Alzheimer’s disease, Parkinson’s disease and HIV dementia.

Since all states are not required to keep data on patients using medical marijuana, it is unclear how many Americans are using the plant for health reasons. One national estimate claims the number to be 2.6 million. According to a recent study by the Pew Research Center estimates:

Nearly half (49 percent) of Americans say they have tried marijuana, and 12 percent in the past year, which the 2012 National Survey on Drug Use and Health says is the most commonly used illicit drug in the U.S. The government survey showed that 18.9 million Americans 12 or older (7.3 percent) had used marijuana in the prior month.

The Pew report does not differentiate between medical use and other use.

What About CBD?

Cannabidiol, or CBD, is a non-psychoactive substance found in the cannabis plant. It has no effect on brain function and is proven to be an antioxidant and neuroprotectant. Are CBD-only medications legal? Nope. Inexplicably, even cannabis devoid of THC, the psychoactive ingredient in marijuana, is considered by the federal government to be Schedule I.

The DEA announced in December that cannabis extracts, including CBD, fall under Schedule I.

So, What About Rescheduling?

It is unlikely that the federal government will do anything soon to change the status of cannabis, despite the fact that more Americans live in states that approve of medical marijuana than states that don’t.

Rescheduling could be achieved via Congress, or through the executive branch. Congress thus far has rejected all bills to reschedule. There is also a provision in the CSA that allows the attorney general the latitude to reschedule administratively.

As mentioned at the top of this article, Congressman Garrett has introduced legislation. But that is seen by most political experts as a symbolic gesture. Just last year, the DEA rejected a call to reschedule.

The first attempt to reschedule occurred in 1972, the same year the act went into effect. NORML petitioned the federal government to move cannabis to Schedule II.

There have been numerous other attempts over the years and all have been unsuccessful.

Note: The 2016 platform of the Democratic Party called for removal of marijuana from Schedule I, “providing a reasoned pathway for future legalization” of marijuana.

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Cannabis and Sleep Disturbances: What You Need to Know

Tue, 10/31/2017 - 08:16
Is your marijuana use helping or hindering your ability to get a good night's rest? Highlights: 
  • Sleep disturbances are the most common health problem in America. Those with sleep issues are poorly served by prescription and over-the-counter sleeping pills and other pharmaceuticals, which have serious risks.

  • CBD and other plant cannabinoids show promise for treating insomnia, sleep apnea, narcolepsy, and other sleep-related disorders.

  • CBD co-administered with THC improves sleep more efficaciously than single-molecule medications.
  • Chronic, heavy consumption of THC-dominant cannabis can disrupt healthy sleep patterns.
  • Our ability to be awake, fall asleep, stay asleep and wake up feeling rested is part of an internal biological process regulated by circadian rhythms and the endocannabinoid system.
Shut-eye overview

Although sleep is essential for our health, its biological purpose is not fully understood. Oddly, the seemingly inactive state of sleep is actually a dynamic and critical process that helps us store memories, build immunity, repair tissue, regulate metabolism and blood pressure, control appetite and blood sugar, and process learning, along with a myriad of other physiological processes – all of which are regulated by the endocannabinoid system (ECS).

According to the National Institute of Neurological Disorders and Stroke at the National Institute of Health (NIH), new findings suggest “sleep plays a housekeeping role that removes toxins in your brain that build up while you are awake.”

Poor sleep is the number one reported medical complaint in the Unites States and a serious public health concern. The average adult needs between seven and eight hours of sleep per day. Yet, 10-30 million Americans regularly don’t get enough sleep.

Over 60 percent of American adults report having problems sleeping several nights per week.

Over 40 million Americans suffer from more than 70 different sleep disorders. The most common sleep-related ailments include:

  • Insomnia - when one cannot fall asleep or stay asleep.
  • Sleep apnea - which involves impaired breathing while sleeping.
  • Restless leg syndrome - characterized by tingling, discomfort and even pain in the legs that increases at night and is relieved by movement.
  • Circadian rhythm disorders - when one’s internal clock is off and one’s sleep patterns are disturbed.
  • Parasomnias - which entails abnormal movements and activities while sleeping, including sleep walking and nightmares.
  • Excessive daytime sleepiness - when an individual experiences persistent drowsiness during daylight hours from narcolepsy or another medical condition.

Poor sleep is a risk factor for serious illness. Compared to people who get enough sleep, adults who are short-sleepers (less than 7 hours per 24-hour period) are more likely to experience one or more of 10 chronic health conditions, including obesity, heart disease, diabetes, arthritis, stroke and depression.

Those with chronic illnesses are at greater risk for insomnia, which exacerbates their discomfort. Comorbid medical disorders – including conditions that cause hypoxemia (abnormally low blood oxygen levels) and dyspnea (difficult or labored breathing), gastroesophageal reflux disease, pain, and neurodegenerative diseases – have a 75-95 percent increased risk of insomnia.

Pills that kill

In 2016, according to the industry research firm MarketsandMarkets, Americans spent $3.38 billion on prescription sedatives and hypnotics, over-the-counter (OTC) sleep drugs, and herbal sleep aids. It’s projected that the market for such products will experience about a 4.5 percent growth rate between now and 2021.

The quest for good night’s sleep can be hazardous to one’s health. Daniel F. Kripke, MD, sleep expert and co-founder of Research at Scripps Clinic Vitebri Family Sleep Center, discusses the dangers of sleep aids in his paper “Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit.”

Dr. Kripke reviewed 40 studies conducted on prescription sleeping pills, which include hypnotic drugs such as zolpidem (Ambien, Edlmar, Intermezzo and Zolpimist), temazepam (Restoril), eszopiclone (Lunesta), zaleplon (Sonata), triazolam (Halcion), flurazepam (Dalmane and Dalmadorm), quazepam, and other barbiturates used for sleep. Of these 40 studies, thirty-nine found that consumption of hypnotics is “associated with excess mortality” to the tune of a 4.6 times greater risk of death for hypnotic users.

Grim statistics: 10,000 deaths per year are directly caused by and attributed to hypnotic drugs, based on medical examiner data. However, large epidemiological studies suggest the number of fatalities may actually be closer to 300,000-500,000 per year. The difference can be attributed to underreported use of hypnotics at the time of death and the fact that prescription hypnotics are rarely listed as the cause of death.

Dr. Kripke concludes that even limited use of sleeping pills causes “next day functional impairment,” increases risk of “on-the-road driver-at-fault crashes,” increases falls and accidental injuries especially among seniors, is associated with “2.1 times” as many new depression incidents compared to randomized placebo recipients, and increases the risk of suicide. Furthermore, the use of opioids combined with hypnotics – two known dose-dependent respiratory suppressants – can be extremely dangerous, especially when mixed with alcohol and other drugs.1

Alarming data

Another concern: Data from controlled hypnotics trials resulted in 12 cancers in hypnotic participants compared to zero cancers in the placebo group. (When the FDA conducted the same audit, they found 13 cancers.) But it is unclear if the hypnotics were a causative factor in these cancers or if they were promoting progression of cancer that had previously gone undetected. Animal and in vitro (test tube/petri dish) studies also attest to the pro-cancer potential of hypnotics. To learn more visit Dr. Kripke’s website.

In addition to these risks, meta-data (combined data) from placebo-controlled randomized clinical trials showed participants in the hypnotic groups had a 44 percent higher infection rate than the placebo participants.

Are over-the-counter sleep aids any better? These also have adverse side effects. Most OTC sleeping pills (Benadryl and others) have the antihistamine diphenhydramine as the primary ingredient. It can knock you out, but it’s unlikely to provide truly restful sleep.

In an email exchange with Project CBD, Dr. Kripke writes: “Usage of diphenhydramine is associated with developing Alzheimer’s disease, though which is cause and which is effect is certainly unclear. One well-known aspect of diphenhydramine is that it is anticholinergic [blocks the neurotransmitter acetylcholine], that produces some heart symptoms sometimes as well as digestive symptoms such as constipation. In some patients, also, diphenhydramine at night causes rather a lot of daytime sleepiness.”

A large number of OTC sleep aids also include acetaminophen, a pain reliever that has a narrow therapeutic window – meaning at one dose it’s therapeutic, but the slightest increase can be toxic to the liver. All too often consumers don’t read the warning labels about these drugs and consume them with alcohol and other meds. This can cause liver toxicity and/or fatal respiratory suppression.

OTC sleep aids are intended only for occasional or short-term use – never more than two weeks at one time. Although it is not typically reported in the published literature, those who use OTC and prescription sleep aids find that once they start it’s hard to stop.

The endocannabinoid system and sleep

Given the problems with conventional soporifics, medical scientists have been exploring other ways to improve sleep by targeting the endocannabinoid system (ECS). As the primary homeostatic regulator of human physiology, the ECS plays a major role in the sleep-wake cycle and other circadian processes.

Italian scientist Vicenzo DiMarzo summarized the broad regulatory function of the endocannabinoid system in the phrase “Eat, sleep, relax, protect and forget.”

How we fall asleep, stay asleep, wake up, and remain awake is part of an internal biological process regulated by our circadian rhythms and our endocannabinoid system. Circadian rhythms govern a diverse array of actions in the body, including hormone production, heart rate, metabolism, and when to go to sleep and wake up.

It’s as if we have an internal biochemical timer or clock that keeps track of our need for sleep, guides the body to sleep and then influences the intensity of sleep. This biological mechanism is affected by external forces such as travel, medication, food, drink, environment, stress and more.

Key question: Does the endocannabinoid system regulate our experience of circadian rhythms or vice versa?

Evidence of a strong relationship between the two is observed in the sleep-wake cycle fluctuations of anandamide and 2-AG (the brain’s own marijuana-like molecules), along with the metabolic enzymes that create and break down these endogenous cannabinoid compounds.

Anandamide is present in the brain at higher levels at night and it works with the endogenous neurotransmitters oleamide and adenosine to generate sleep. Conversely, 2AG is higher during the day, suggesting that it is involved in promoting wakefulness.

The highly complex sleep-wake cycle is driven by a variety of neurochemicals and molecular pathways.2 Both anandamide and 2AG activate CB1cannabinoid receptors that are concentrated in the central nervous system, including parts of the brain associated with regulating sleep.

CB1 receptors modulate neurotransmitter release in a manner that dials back excessive neuronal activity, thereby reducing anxiety, pain, and inflammation. CB1 receptor expression is thus a key factor in modulating sleep homeostasis.

This is not the case, however, with respect to the CB2, the cannabinoid receptor located primarily in immune cells, the peripheral nervous system, and metabolic tissue. Whereas CB1 receptor expression reflects cyclical circadian rhythms, no such fluctuations have been described for the CB2 receptor.

The challenge of studying and treating sleep disturbances is complicated by the fact that sleep disorders are symptomatic of many chronic illnesses. In many cases, poor sleep results in chronic illness, and chronic illness always involves an underlying imbalance or dysregulation of the endocannabinoid system. Although we still have much to learn about the relationship between the ECS and circadian rhythms, it’s clear that adequate quality sleep is a critical component of restoring and maintaining one’s health.

Cannabis for slumber

Cannabinoids have been used for centuries to promote sleepiness and to help people stay asleep. In the acclaimed medical reference Materia Medica, published in the 18th century, cannabis was listed as a ‘narcotica’ and ‘anodyna’ (pain reliever). Its reintroduction to Western medicine by Sir William B. O’Shaughnessy in 1843 led to studies that underscored the remedial properties of “Indian hemp” for sleep disorders.

“Of all anaesthetics ever proposed, Indian hemp is the one which produced a narcotism most closely resembling the natural sleep without causing any extraordinary excitement of the vessels, or any particular suspension of secretions, or without fear of a dangerous reaction, and consecutive paralysis,” German researcher Bernard Fronmueller observed in 1860.

Nine years later Fronmueller reported that in 1000 patients with sleep disturbance, Indian hemp produced cures in 53 percent, partial cure in 21.5 percent, and little or no effects in 25.5 percent.

Sleep-related problems continue to drive a large percentage of people to seek relief with cannabis.

Poor sleep and lack of sleep cause physiological changes in the body after just one night, resulting in slower reaction times, deceased cognitive performance, less energy, aggravated pain and inflammation, and in many cases overeating or cravings for high-fat, high-carbohydrate “comfort” foods.

A 2014 study by Babson et al notes that approximately 50 percent of long-term cannabis consumers (over 10 years) report using cannabis as a sleep aid. Among medical marijuana patients, 48 percent report using cannabis to help with insomnia.

Another study revealed that 40 percent of insomniacs also suffer from anxiety and depression or another a psychiatric disorder. (Roth, 2007) Would it surprise you to learn that people with mood disorders who use cannabis have the highest rates of sleep benefit at 93 percent? (Babson & Bonn-Miller, 2014)

“Sorrow can be alleviated by good sleep.” So said Thomas Aquinas.  CBD, THC, CBN

What about specific plant cannabinoids for sleep?

Cannabidiol (CBD) is alerting or mildly stimulating in moderate doses, while its psychoactive counterpart delta 9-tetrahydrocannabinol (THC) tends to be sedating. However, the science is somewhat paradoxical.

Research data and anecdotal accounts indicate that CBD and THC have differential effects on sleep – both can be alerting or sedating depending on dosage.

The biphasic dose response triggered by CBD and THC is one of the factors that may contribute to conflicting research results with respect to cannabinoids and sleep.3

The association between low-dose cannabidiol and increased wakefulness underscores CBD’s potential as a treatment for narcolepsy and other variants of excessive daytime sleepiness.

Curiously, CBD can help people fall asleep as well as stay awake. An insomnia study indicated that the administration of 160 mgs of CBD decreased nighttime sleep interruptions and increased total sleep time, suggesting that high-dose CBD therapy can improve the quality and duration of sleep.

In addition to showing promise as a safe and effective alternative to conventional psychiatric treatments for insomnia, cannabidiol can reduce symptoms of REM behavior disorder (RBD), which is characterized by the acting out of vivid, intense, and sometimes violent dreams. A preliminary study examined the efficacy of CBD in patients with both Parkinson’s disease and RBD and the results were encouraging.

Obstructive sleep apnea (OSA) is a prevalent form of sleep disorder breathing that affects nine percent of American adults. Research involving animal models of this condition has shown that THC and the endogenous cannabinoid oleamide are effective in reducing sleep apnea events. (Babson 2017) Human studies indicate that dronabinol, a FDA-approved synthetic version of THC, reduces sleep apnea and is safe and well tolerated.

Additionally, cannabinol (CBN), most commonly associated with aged cannabis, is said to potentiate the sedative properties of THC when these two cannabinoids are used together, although this notion may be more modern-day marijuana folklore than scientific fact.

Pain and sleep

Besides the desire for good sleep, treating pain is another common reason for using cannabis. Chronic pain is a major public health issue that directly affects around 20 percent of U.S. adults, many of whom also suffer from diminished sleep. Sometimes it’s hard to know if the pain is causing sleeplessness or if sleeplessness is triggering the pain.

Patients seeking both pain relief and better sleep may achieve positive results with cannabinoids and other cannabis components.4 In their paper “Cannabis, Pain, and Sleep: Lessons from Therapeutic Clinical Trials of Sativex®, a Cannabis-Based Medicine,” Russo et al summarized 13 studies that examined varying cannabis preparations for pain and sleep.

Of particular interest is a Phase II study, involving 24 patients with intractable multiple sclerosis, which compared three different preparations: Tetranabinex (a high THC product); Nabindolex (high CBD); and Sativex® (an almost a 1:1 THC:CBD sublingual remedy).

Different cannabinoid ratios helped in various ways: “Compared to placebo, the CBD-predominant extract significantly improved pain, the THC-predominant extract yielded significant improvement in pain, muscle spasm, spasticity and appetite, and combined THC:CBD extracts (Sativex®) significantly improved muscle spasm and sleep.”

The authors concluded that a combination of CBD and THC (15 mg of each) “improved sleep synergistically.” Of the thirteen studies profiled in this paper, seven showed improvements in sleep. Six of the seven were conducted with Sativex®, the 1:1 CBD:THC sublingual spray, indicating that balanced a cannabinoid profile facilitates sleep improvements among patients with chronic pain.5

The gift of forgetting

The use of cannabis is prevalent among those who suffer from post-traumatic stress disorder (PTSD). A small open trial conducted in Israel showed that 5 mg of smoked THC twice a day resulted in improved sleep and reduced frequency of nightmares in patients with PTSD. (Mechoulam, 2015) This directly correlates with similar test results involving nabilone, a synthetic THC-like drug.

Memory processing occurs when we are asleep, so it stands to reason that someone suffering from PTSD– especially those who experience nightmares – would benefit by using cannabis or cannabinoids to sleep better.

At first glance, it may appear that cannabis is merely a coping mechanism for PTSD patients; it is sometimes negatively characterized this way in the medical literature. Thus far, the majority of studies involving cannabinoids and PTSD have been conducted from an addiction perspective – will cannabis harm PTSD patients and turn them into addicts? – but that may be changing.

Increasingly researchers are recognizing the limitations of the addiction framework, which overlooks the crucial role that the endocannabinoid system plays in helping us forget painful memories, a normal process that is somehow dysregulated when one experiences PTSD.

In some cases, THC and other plant cannabinoids can provide enough relief so that PTSD sufferers are able to embark upon the task of making sense of their traumatic memories and begin the healing process. None of that can happen without quality sleep.

“If you can’t sleep your world goes to hell in a hand basket real fast,” said Al Byrne, a U.S. Navy veteran and medical marijuana advocate.

Many military veterans and victims of sexual abuse are using cannabis to treat their PTSD-related symptoms. A 2016 case study provided clinical data that validated the use of CBD-rich oil as a safe and effective treatment for reducing anxiety and improving sleep in a young girl with PTSD.

Pharmaceuticals provided minimal relief for a 10-year-old girl who had been sexually abused as a young child. And her meds caused major adverse side effects. But a CBD-rich oil regimen resulted in “a maintained decrease in anxiety and a steady improvement in the quality and quantity of the patient’s sleep.”

This is not an isolated example. CBD-rich oil, an increasingly popular treatment for anxiety and sleep problems, has emerged in recent years as a viable alternative to Big Pharma drugs.

Dosing for slumber

Cannabis therapeutics is personalized medicine – and this is certainly true with respect to using the herb and its components to treat sleep disorders. The effectiveness of cannabis as a sleep aid is highly variable, depending on the individual user, how the remedy is administered, its cannabinoid ratio and aromatic terpene profile, the timing and dosage – all these factors come into play and influence different outcomes.

Success may rest upon how well one manages the psychoactive qualities of cannabis. As with any medicine, there are some risks involved when consuming cannabis to sleep better. Short-term use of cannabis may decrease sleep onset latency (how long it takes to fall asleep). But this improvement may weaken over time. Tolerance develops with chronic consumption, which can impair long term sleep quality.

Too much of a good thing can be problematic for frequent recreational cannabis users, who may begin to experience a reduction in slow-wave deep sleep, leaving the individual feeling like they are not well rested. Could this be because recreational users tend to prefer large amounts of THC-dominant cannabis varieties?

Sleep disturbance, ironically, is perhaps the most notable withdrawal symptom when a heavy user stops smoking marijuana. Compared to kicking addictive pharmaceuticals, cannabis withdrawal is a minor discomfort with symptoms typically lasting for a few days (sometimes a few weeks) after cessation. And cannabis, unlike prescription and over-the-counter sleep aids, has never killed anyone.

Medical cannabis users often experience better outcomes with lower doses, especially when they are treating something in addition to sleep disturbances, such as pain, spasticity, or post traumatic stress disorder. Based on the available literature reviewed by Project CBD, it appears that a 1:1 CBD:THCpreparation will most likely confer restorative sleep. Cannabis-naïve patients may find relief with as little as 2.5 mg of THC and 2.5mg CBD. A somewhat higher dose – 5 to 15 mg each of THC and CBD – may work wonders for experienced cannabis users.

The combination of odiferous terpenes present in a given cannabis strain or product can also significantly impact sleep. Individual terpenes have sedating or stimulating effects, thus affecting the sleep-wake cycle. Terpenes can be therapeutic in their own right. As important modulators of cannabinoids, terpenes contribute significantly to how a given cannabis strain or cultivar makes one feel.

Sedating terpenes include terpinolene, nerolidol, phytol, linalool, and myrcene. In addition to causing the infamous “couch-lock” effect at high levels (+0.5%), myrcene can be mildly stimulating at lower levels. Those trying to address pain and sleep issues should consider cannabis remedies that include beta-caryophyllene, as this terpene is also a strong anti-inflammatory and pain-reliever.

Practical Tips for Improving Sleep

In a study published in the Journal of the American Medical Association, 27 percent of respondents indicated that they used complementary, non-pharmaceutical therapies for fatigue and 26.4 percent for sleep deprivation.

Here are a few simple lifestyle modifications and holistic healing options that may improve your sleep quality.

  1. Create an inviting sleep environment. Having a comfortable bed in a relaxing environment is key to quality sleep. Reduce outside or harsh overhead lighting and maintain a comfortable temperature for sleeping. And, reduce noise. If you are a light sleeper consider using a white noise machine to drown out unwanted sound. Salt lamps may help clean the air by reducing negative ions (and provide enough light to get to the bathroom without intruding on sleep).
  2. Have a sleep routine. Going to bed and waking at the same time seven days a week is optimal. Additionally, it is helpful for some people to have a relaxing bedtime routine that lets the mind know it is time to get sleepy. This may include a small warm cup of milk or green tea 45 minutes to an hour before bed, or a few simple yoga stretches to relax, or an Epsom salt bath.
  3. Avoid overstimulation. It is best not to have a television in the bedroom and not to watch violence shows before bedtime, especially for those with adrenal fatigue. Avoid reading or using your phone, laptop or tablet in bed.
  4. Exercise daily. Regardless if your preference is jogging, weightlifting, gardening, walking or tai chi, do some form of exercise every day. But avoid exercising within two hours of bedtime.
  5. Avoid stimulants after 1PM. Caffeine, alcohol, tobacco, certain herbal supplements and drugs may leave you feeling “hyper” and overstimulated, which can impede the brain’s ability to transition into sleep.
  6. Aromatherapy. Many of the sedating essential oil components present in cannabis can also be found in other plants at your local grocery or natural products store, along with misters that spay the oil into the air. Aromatherapy can be relaxing and very helpful to induce sleep. Lavender essential oil, for example, can be help to manage certain sleep disorders.
  7. Use sleep supporting herbs. It is best to work with a healer or someone knowledgeable about herbs and supplements instead of buying whatever sleep cure is touted on the internet. Herbs that have sleep-promoting properties include Valerian, Kava, German Chamomile, Roman Chamomile, Passion Flower, California Poppy, Hops, Lemon Balm, Linden, Skullcap, and Oats. Visit the American Herbalist Guild to find a qualified practitioner.
  8. Nutritional supplements. Consult your physician about products made with Kava, calming minerals, and taking the right kind of magnesium at night.
  9. Other therapies. In addition to cannabis, safe holistic healing alternatives include cognitive-behavioral therapy for insomnia, and bright light therapy for circadian rhythm disorders.

Footnotes

1 In 2014, there were 47,055 accidental opiate overdose deaths. Dr. Daniel Kripke estimates one third of them also involved various hypnotics as a cause of death. It should be noted that cannabis has been shown to improve safety and effectiveness of opiates making it possible for the patient to take a lower dose, thereby reducing the risk of side-effects including death. In some cases, cannabis can replace both the opiate as an effective painkiller and the hypnotic.

2 Highly complex, the sleep-wake cycle is driven by various neurochemicals and brain pathways. Neuroscientist and sleep researcher Dr. Eric Murillo-Rodriguez, says that “Sleep is generated by sleep-promoting neurons placed in the anterior hypothalamus that utilize GABA to inhibit wake-promoting regions in the hypothalamus and brainstem. Then, the brainstem regions inhibited during wake and slow wave sleep become active during rapid eye movement sleep (REM).”

3 In “The effects of cannabinoid administration on sleep: a systematic review of human studies,” Gates et al scrutinized cannabis-related sleep studies prior to 2012. But they found “little consistency in the results [of] six studies with objective sleep measures. Slow wave sleep was described as increasing for a week in one study, whereas three studies reported a decrease in slow wave sleep, and one study showed no change. Rapid eye movement sleep was reported to increase in one study, decrease in a second study, while four studies showed no effect. Stage two sleep [see sidebar] was reported to increase in two studies, while four studies showed no effect. Sleep latency was reported to increase in one study, decrease on a high THC dose in a second study, while two studies showed no effect and two studies did not measure sleep latency.”

4A 2014 article by Babson & Bonn-Miller indicated that over 83 percent of surveyed patients taking cannabis for pain said they experienced improved sleep.

5Nicholson et al had similar results in a double-blind placebo-controlled with a 4-way crossover design study evaluating the effect of cannabis extracts on nocturnal sleep, early-morning performance, memory, and sleepiness in eight subjects ages 21-34 years old. A cross-over design is one where each group of participants take two or more interventions; in this case four different preparations were tested, including THC (15 mg) alone; THC and CBD together (5 mg each and 15 mg each); and a placebo. They scientists found that “although impaired memory was observed the next day when 15 mg THC was given alone overnight, there were no effects on memory when 15 mg THC was ingested with 15 mg CBD.” They also found that the effects of THC and CBD appeared to be dose dependent as evidenced by the fact that 7.5 mg of THC did not impair memory, but 15 mg did.

Copyright, Project CBD. May not be reprinted without permission.

Sources

  • Americal Sleep Association. (2017, July 7). Sleep Statistics. Retrieved from American Sleep Associaton:https://www.sleepassociation.org/sleep/sleep-statistics/
  • Babson, Kim A., Bonn-Miller, Marcel O. (2014). Sleep Disturbances: Implications for Cannabis Use, Cananbis Use Cessation, and Cananbis Use Treatment. Current Addiction Reports, 109-114.
  • Babson, Kimberly A. and James Sottile, Danielle Morabito. 2017. “Cannabis, Cannabinoids, and Sleep: Review of the Literature.” Current Psychiatry Report.
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The Kids Are Alright: Today's Teens Aren't As Into Drugs, Alcohol, or Theft

Tue, 10/31/2017 - 08:00
Teen substance abuse disorders have declined by nearly half in the past 12 years, even as pot legalization spreads and the opioid epidemic festers.

Today’s teens are far less likely to abuse alcohol, nicotine, and illicit drugs, and are also less likely to engage in delinquent behaviors, such as fighting and stealing, according to a study of more than 200,000 teens.

The findings come from the National Survey on Drug Use and Health, an annual survey of 12- to 17-year-olds from all 50 states that is sponsored by the Substance Abuse and Mental Health Administration, an agency of the US Department of Health and Human Services.

The data include information from 2003 through 2014, the last year for which survey numbers are available. A total of 210,599 teens—13,000 to 18,500 each year—were part of the study.

The number of substance-use disorders among 12- to 17-year olds declined by 49 percent over the 12-year span, along with a simultaneous 34 percent decline in delinquent behaviors, such as fighting, assault, stealing, selling drugs, or carrying a handgun.

The drop in substance abuse among teens parallels findings in other recent surveys, but until now no one has looked at how the drop-off may be linked to other behavioral issues.

“We’ve known that teens overall are becoming less likely to engage in risky behaviors, and that’s good news,” says Richard A. Grucza, a professor of psychiatry at Washington University in St. Louis and first author of the study in Psychological Medicine.

“But what we learned in this study is that the declines in substance abuse are connected to declines in delinquency. This suggests the changes have been driven more by changes in adolescents themselves more than by policies to reduce substance abuse or delinquent behavior.”

Previous studies show that teens are delaying sex and using seat belts more often than their parents and grandparents. The new work focused on substance-use disorders—involving alcohol, nicotine, marijuana, opioids, and the abuse of other prescription drugs or nonprescription drugs—and delinquent behaviors.

“It’s not clear what is driving the parallel declines,” Grucza says. “New policies—including things like higher cigarette taxes and stricter anti-bullying policies—certainly have a positive effect.

“But seeing these trends across multiple behaviors suggests that larger environmental factors are at work. These might include reductions in childhood lead exposure, lower rates of child abuse, and neglect, and better mental health care for children.”

Although heroin and opioid abuse have become epidemic in many areas of the United States, the use among teens has fallen, the survey data show.

“Opioid problems continue to increase among adults,” Grucza says. “But among the 12- to 17-year-old population, we saw a drop of nearly 50 percent.”

Based on the survey data, Grucza and his team estimated that in 2014 there were nearly 700,000 fewer adolescents with substance-use disorders than in 2003. And because it’s possible for a person to be addicted to nicotine while abusing alcohol or marijuana, the researchers estimate the total number of substance-use disorders among adolescents declined by about 2 million.

The National Institute on Drug Abuse of the National Institutes of Health supported the work.

Source: Washington University in St. Louis

Original Study DOI: 10.1017/S0033291717002999, 

 

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Why Should Taxpayers Pay for the Opioid Crisis When Pharma Caused It?

Mon, 10/30/2017 - 13:48
Click here for reuse options! Trump has announced a national public health emergency over opioids for a scourge created by Pharma.

As everyone today knows, opioid narcotics like fentanyl, hydrocodone, hydromorphone, morphine and oxycodone have created a toxic epidemic in the United States with at least 100 daily overdose deaths. This happened because Pharma paid off doctors, medical associations and federal lawmakers to loosen opioid regulations.

There was a reason narcotics were traditionally limited to severe pain cases, not "everyday" pain—they are addicting and can kill, as we are now seeing. But Pharma—especially the Sackler family's Purdue which makes OxyContin—banked on the fact that younger doctors and patients did not remember why narcotics were so heavily restricted. They were right.

As new Pharma-driven prescribing guidelines were drafted and the industry-appeasing FDA waved new pills and patches through despite daily deaths, brazen "pill mills" and "Oxy docs" popped up, as did legions of addicts. Soon "opioid addiction" treatment clinics popped up to play the other side of the street—the addictions caused by the pill mills—further enriching Pharma.

Not only can narcotics like the popular OxyContin, Vicodin, Percocet and the fentanyl patch lead to coma, respiratory depression, shock, pulmonary edema and death, but studies suggest they can increase a body's sensitivity to pain and make pain worse—a phenomenon called opioid-induced hyperalgesia. The drugs also cause constipation, hormonal derangement and negative mental changes.

The label on Purdue's OxyContin says "WARNING: ADDICTION, ABUSE AND MISUSE; LIFE-THREATENING RESPIRATORY DEPRESSION; ACCIDENTAL INGESTION; NEONATAL OPIOID WITHDRAWAL SYNDROME; CYTOCHROME P450 3A4 INTERACTION; and RISKS FROM CONCOMITANT USE WITH BENZODIAZEPINES OR OTHER CNS DEPRESSANTS."

Many opioid addicts began their downward spiral with opioid prescriptions they should never have been given for chronic pain. Unlike acute pain, chronic pain should seldom if ever be treated with opioids, but thanks to the short-term pill approach of our health care system, it usually is. The cost to society of the opioid epidemic in crime, disability, treatment of addiction and overdoses, lost wages and of course deaths has yet to be fully calculated.

"The problem is, patients are started, develop tolerance, need a higher dose, get tolerant to the higher dose, use more than prescribed, ask for early refills, get switched to a 'pain management specialist,' who if they violate the pain contracts, get fired, discharged, and then they go to the street for the opioids," says James O'Donnell, a pharmacology professor at Rush University in Chicago.

The following medical case from a pharmaceutical textbook shows just how dangerous opioid drugs can be, whether derived naturally from poppies or created synthetically by chemists:

"A 35-year-old divorced male school teacher and wrestling coach in a southwestern state was seen by a sports medicine specialist. He had complained of chronic low back pain, and he had been taking hydrocodone/acetaminophen for the pain. The sports specialist was concerned about acetaminophen toxicity, and prescribed 'low dose' methadone, 10mg twice daily, and discontinued the hydrocodone/acetaminophen. The next day, he stayed at his parent's home. He was very drowsy, sleeping on and off most of the day, and went to bed early. In the late morning of the third day, his mother was unable to awaken him. He was declared dead by EMS."

Trump has announced a national public health emergency over opioids for a scourge created by Pharma. When the extent of damage from cigarettes was revealed, Big Tobacco agreed to cease advertising and to pay, in perpetuity, various states to compensate them for some of the medical costs of caring for persons with smoking-related illnesses. Like Pharma, Big Tobacco said cigarettes "weren't addictive."

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Teen Busted for Pot, Then Raped by New York City Cops

Mon, 10/30/2017 - 10:04
Click here for reuse options! As if we needed even more reasons to end marijuana prohibition.

A New York City grand jury indicted two Brooklyn narcotics officers late last week on charges they raped an 18-year-old woman after arresting her for smoking marijuana. The victim says she was assaulted while handcuffed in the back of a police van in the parking lot of a Chipotle restaurant in September.

The two narcotics officers, Eddie Martins and Richard Hall, face charges of first-degree rape. The victim, who posts on social media under the name Anna Chambers, alleges that both narcs forced her to perform oral sex on them and one of them raped her.

According to Chambers, she and two young men were pulled over by Martins and Hall for smoking pot, and they targeted her after finding prescription drugs in the car. The narcs told her companions to leave before ordering her to undress so they could "search for drugs."

They didn't find any drugs on her, but handcuffed the teen anyway before coercing her into sex, her attorney, Michael David, said.

"You'll spend three hours in the precinct," they allegedly told her. They also allegedly said: "This is what you're going to do for us, and we'll let you go," David said.

"There was zero consent," David said. "The cops were over 6 feet tall. She's very petite, like 5'2" and maybe 100 pounds. There's nothing she could do."

The grand jury issued the indictments October 26 after hearing a week of testimony, including testimony on the stand from Chambers. The narcs were not arrested upon indictment, but are expected to turn themselves in this week. They have been placed on modified duty and stripped of their guns and badges and are now suspended without pay. They're looking at between three and 25 years in prison if convicted.

The detectives, from NYPD's Brooklyn South narcotics squad, have not denied that they engaged in sex acts with Chambers, but claimed they were consensual. They spent the past week trying to discredit and impugn their accuser.

In a letter to prosecutors, lawyers for the narcs pointed out she had filed a $50 million claim against the city in October and had posted "provocative" selfies on her Instagram and Twitter accounts after the assault. The lawyers called on prosecutors "to further investigate Chambers' dubious claim before you ask the grand jury to return an indictment against Martins and Hall."

Chambers furiously rejects the narcs' claim that the sex was consensual, her lawyer said.

"She was shocked that the [cops] would say it was consensual after everything that was done to her. She wanted to get the word out," David told the New York Post. "She just wants everybody to know it's an absolute lie that this was consensual. She was raped. She was viciously, brutally raped in handcuffs. It's the truth," he said.

"She's embarrassed," David continued. "She's very depressed over this. Her whole life had changed after this experience. She's afraid of the police, and she really wants justice to be served here."

After the attack, Chambers did what victims are supposed to do: She sought help at NYU Langone Hospital, which performed a rape kit on her that found the cops' DNA. She reported the sexual assault to police. She confided in friends about the assault, and she filed a civil lawsuit. And now, the criminal justice system swings into action against the perpetrators.

One of the reasons the war on drugs is so loathed is that it provides the opportunity for crooked cops to abuse their power in ways like this. One wonders how many similarly abused women have not come forward. 

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Opioid Epidemic Shares Chilling Similarities With Past Drug Crises

Mon, 10/30/2017 - 08:35
We've been here before, and there are lessons to be learned.

 

 

Opioid epidemic shares chilling similarities with past drug crises

NEW YORK (AP) - While declaring the opioid crisis a national public health emergency Thursday, President Donald Trump said: "Nobody has seen anything like what's going on now." ... , an outcast in a society of outcasts. He is regarded as a fool by heroin addicts, as insane and violent by those using psychedelics and marijuana, and a ‘bust' by non-drug using hustlers," wrote Dr. Roger Smith ...{C}

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Marijuana Can Help The 12 Million Patients Suffering From Spasticity

Mon, 10/30/2017 - 08:19
In Canada, 1 in 5 of MS patients currently use medical marijuana.

Could cannabis be the new, improved answer for patients suffering from spasticity? The roughly 12 million people worldwide who are thought to suffer from the condition would love to hear that news. Spasticity, like it sounds, refers to a variety of involuntary muscle spasms and stiffness. It is a very common symptom of multiple sclerosis, but it can also be the result of other conditions such as cerebral palsy, stroke and brain or spinal cord trauma. 

Using cannabis for calming muscles is not a new approach. In the mid-1840s, before prohibition, physicians prescribed cannabis tinctures and extracts for inflammation, muscle spasms, delirium tremens (DTs) and a host of other conditions.

The traditional modern treatments for spasticity includes use of muscle relaxants like baclofen, injecting people with botulism and physical therapy. Sometimes the situation is so dire that the patient even resorts to surgery to implant muscle relaxant pumps and to permanently sever the roots of nerves.

Times and approaches change. Since 2010, Canadian patients have had access to Sativex, a prescription combination of THC and CBD in a peppermint flavored oral spray. 

A large study looked at the use of Sativex by over 900 patients in the UK, Germany and Switzerland with treatment-resistant multiple sclerosis spasticity. The patients were given the drug for daily dosings and evaluated to see how well they maintained their therapy regimen. The study revealed that 68 percent of the patients voluntarily stayed on their cannabis medicine at least one year. An additional 207 Spanish patients in specialized MS centers had equally successful “continuation rates” of staying on the cannabis-based medicine.

Additionally, German researchers studied 16 young patients ranging in age from 1 to 26 with “complex neurological conditions with spasticity.” The subjects were given daily drops of a synthetic cannabinoid, dronabinol (Marinol). Researchers concluded that “in the majority of pediatric palliative patients, the treatment with dronabinol showed promising effects in treatment resistant spasticity.” 

It’s not magic, but it may feel that way to people whose conditions have been hard to manage and have not had success with other therapeutic approaches. THC is believed to engage the endocannabinoid system to block inflammation and improve the natural communication between muscles and nerves. Some researchers believe that this reduction in inflammation can even slow the progression of the disease and the increasing disability it creates.

The good news is that the word is spreading about the potential impact of cannabis on spasticity, particularly among the MS patient community.

In Canada alone, one in five MS patients currently use medical marijuana in some form. For these patients and others who experience the debilitating condition of spasticity, this is hope, and hope is profoundly important.

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Here’s What Donald Trump Should Have Said About Opioids

Mon, 10/30/2017 - 06:39
Click here for reuse options! The harm stops here.

My Fellow Americans,

Families, communities, and citizens across our country are in crisis due to the dramatic escalation in opioid overdoses. While some other countries are struggling with increased overdose rates, the problem is far worse here. And it’s time that we ask ourselves why: Why is it that after billions of dollars spent on trying to stop illegal drugs from coming into the US, today opioids are as plentiful as ever? Why is it that decades since Nancy Reagan urged American kids to “just say no,” demand is as high as ever? And why are so many people dying?

A big part of the answer is that the war on drugs has failed to deliver on its promises.

Arresting and locking up people who use drugs has only driven them underground, making it less likely they’ll seek help when they need it. The lack of meaningful public education about drugs, their real effects, and the concrete risks around them — for example, that the risk of death goes up when opioids are mixed with alcohol — means that those who try drugs are likely to do so in riskier ways. The criminalization of drugs means it’s impossible for people who use drugs to get their supply tested, and to find out whether it’s adulterated with unwanted substances like fentanyl.

The billions of dollars we have poured into going after the drug trade, both abroad and at home, have only enhanced the profitability of the drug market for organized crime. As a result, criminal groups have near-limitless financial resources to develop ever more inventive methods to keep the supply going, to corrupt authorities, and to ruthlessly protect their share of the market.

The "collateral damage" of this unwinnable war? Devastated families across the US.  Not just the families of the 64,000 people who died of an overdose in 2016, but the countless others, particularly in communities of color that have been aggressively targeted by police, whose loved ones have been locked up or deported for low-level drug offenses. Abroad, the cost has included hundreds of thousands of people killed in countries from Mexico to the Philippines.

Rather than solving problematic drug use, the war on drugs has metastasized into a decades-long national and global disaster. It has criminalized a public health issue and inflicted death, incarceration, and untold billions in wasted US tax dollars on multiple generations of Americans. Enough is enough.

I’m here to propose a different approach.

Today, I am officially declaring the opioid crisis a national public health emergency under federal law.

We will never be able to stop all people from using drugs, and we shouldn’t try. Our goal should be to minimize the harms — like overdose — that can flow from drug misuse, while avoiding causing greater harms in the process.

We will take immediate action to prevent overdose by funding community-based programs to provide the life-saving overdose-reversal medication naloxone, working to lower its price, and removing barriers to accessing it elsewhere. We will work with states so they improve, pass, and implement Good Samaritan laws, and stop  prosecutions of people who are present at the time of an overdose. Nobody should be afraid to call 911 to save a life.

We will not coerce people into treatment through criminal justice tools or drug courts, as too often that only does further harm by landing people in prison. For those who want it, we will increase access and eliminate red tape around evidence-based treatment, including the medications methadone and buprenorphine, which have proven far more effective than other options. We will put resources into researching and evaluating new treatment and pain management modalities, including medical marijuana.

We will promote mechanisms that have proven effective to reduce the harms associated with drug misuse. That includes safe consumption facilities, where people who use drugs can consume them under the supervision of trained professionals, who can monitor them for overdose and refer them to treatment or other support as needed. We will provide free drug checking services in communities across the country, so people who use opioids can ensure they’re not adulterated in ways that increase their risk.

Rather than resort to fear-mongering, we will equip our young people with knowledge, warning them about the risks of drug misuse in a realistic and scientifically grounded way. We cannot control all their choices, but by treating them with respect and giving them sound information, we can ensure they have what they need to make good choices for themselves.

Right now, we will stop putting law enforcement resources into arresting people for drug use and possession. We must stop treating people who use drugs as criminals, and stop using the war on drugs as an excuse for persecuting Black, brown, and immigrant communities. Instead, we will invest those resources in addressing the many other needs of the communities that have been worst hit by the war on drugs — particularly among people of color.

It will take many years and even decades to undo the terrible harms wrought by the war on drugs, but we must start in earnest now.

The harm stops here.

This piece first appeared on Salon

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