Advancing Medicinal Marijuana to a Higher Standard

//Advancing Medicinal Marijuana to a Higher Standard

Advancing Medicinal Marijuana to a Higher Standard

Good morning! On behalf of myself and the rest of the IndicaMD staff, we would like to welcome you to our educational website, weekly blog and recommendation and certification service. The rapidly changing landscape with regard to medicinal marijuana warrants timely updates and thoughtful insights into a substance frequently misunderstood and often relegated by providers in the United States and many other nations. The goal of the IndicaMD program is to firstly educate others on the role of cannabinoids in the modern pharmacopeia, secondly to inform patients about the medicolegal aspects of medicinal marijuana usage and thirdly to evaluate patients to ascertain if they will benefit from cannabis. This evaluation also entails thoroughly gauging to see if no significant contraindications preclude usage and then to appropriately recommend/certify for using medicinal marijuana for the ailment(s) in question. Although cannabinoids promise benefit in a large number of maladies, many of which remain controversial, they can only be recommended for patients that qualify by virtue of state-specific guidelines. As strong supporters of the federalist system in place in our great nation, IndicaMD abides by all laws regarding any transaction involving cannabinoid recommendations/certifications (this website has no association whatsoever with producing or obtaining cannabis).

The ongoing story of medicinal marijuana in the state of Nevada is a case in point entwined with the laws passed forth from Nevada’s state capital, Carson City. At seemingly warp speed, the state of Nevada approved the sale of recreational marijuana starting on July 1st, 2017. Within days, state dispensaries were experiencing a shortage of cannabis due to sales even higher than the very high sales expected. Although Nevada dispensary owners and others predicted massive interest with the debut, even this was not fully foreseen. Recently, the governor of Nevada has gone so far as to consider declaring a “state of emergency” given the anticipated plunge in available cannabis in storefronts from Las Vegas to Reno¹.

In many ways, the story of hemp parallels the story of the United States. I will save extensive details about the history of cannabis for other blog posts but what is quite relevant today is its ongoing relationship with our federalist system of government. Simultaneously, there are federal regulations and state regulations that we seek to respect, honor and carry out. Our organization and employees adhere to the law in full and therefore you may see subtle and not-so-subtle differences in management of patient logistics based upon locale. Although human physiology and the endocannabinoid system remain essentially unchanged from person to person, state laws have considerable variation. The anticipated expansion of recreational marijuana programs in states in which they are permitted furthers known differences in the manner in which cannabis is discussed, produced and obtained.

Commenting on the nature of medicinal marijuana in California, I can discuss my own experience as a neurologist having seen rapidly escalating interest in cannabis to treat various ailments. Truly, over the course of the most recent academic year, interest seems to have tripled. There are some days in clinic when the topic of medicinal marijuana comes up 3-4 times before close of business.

It is with pride that I state both of my alma maters, UC-Irvine and UCLA, are at the forefront of cannabis education in the United States. The Orange County Register recently announced that UC-Irvine is on its way to developing the first ever multi-disciplinary cannabis research center in the world². It was also this calendar year that UCLA hosted its Inaugural 2017 Cannabis Research Symposium, a heavily attended event that is sure to draw an encore presentation in 2018³.

An area of considerable interest in the medicinal marijuana community remains that of using cannabis to treat pediatric patients. This website alone has already shown itself of sustained interest to concerned parents/grandparents and their very young dependents. These dependents are seeking to try medicinal marijuana given the failure of other treatment regimens with regard to autism and a host of other concerns commonly encountered in the pediatric world. Unfortunately, until greater insight is gained by myself and the other physicians on staff, or we hire a pediatric consultant with growing expertise in this domain (which is proving itself a very difficult task to find such a specialist), we will continue to outright deny recommendations/certifications to any patient under the legal age of adulthood (18).

Nonetheless, we strongly encourage concerned parents and guardians to reach out to us and see what can be done for their loved ones. We are in the process of seeking out a network of competent and capable providers in the pediatric realm willing to, at minimum, provide information relevant to pediatric patients that we adult practitioners do not currently possess. However, we fully expect our knowledge base to expand and adapt with time. Please follow our website as we look to augment our knowledge base and roster of available practitioners.

One of IndicaMD’s many aims is to make sure America’s veteran defenders have access to medicinal marijuana when and where appropriate. IndicaMD will continue to offer an appreciation discount for all of the men and women who have bravely volunteered to stand in harm’s way on behalf of the United States. We honor the sacrifice you have made for us and it only makes sense that we offer an appreciation in return. In addition to former members of the armed forces, IndicaMD would also like to extend our appreciation rate to our domestic heroes, those who have served in either the police or fire departments of the municipalities we service. Please directly notify your IndicaMD physician of your status with the service to make them aware when you first log in.

IndicaMD is and always will be a physician-run organization. At this moment in time, every member of IndicaMD’s health care staff is a physician. We have great respect for physician assistants (PAs) and nurse practitioners (NPs) but at this time IndicaMD positions are only open to medical doctors. This means that every encounter for every patient will involve, at a minimum, a face-to-face telehealth visit or in-person visit with an IndicaMD state-licensed physician.

For women of childbearing age, do not be alarmed if your IndicaMD consultant physician asks about pregnancy or breastfeeding. In fact, it is of utmost importance that we counsel female patients of childbearing age to stop using medicinal marijuana in the advent of pregnancy or a period of breastfeeding. There is a known association between mothers who use cannabis and low birth weight infants, and given that we know medicinal marijuana can potentially be transferred via breast milk, we advise breastfeeding mothers to also suspend medicinal marijuana during the period of breastfeeding.

Another significant contraindication to the usage of medicinal marijuana is a history of schizophrenia in oneself or a first-degree relative. A first-degree relative is a brother, sister or parent (mother or father). The category of second-degree relatives includes uncles, aunts, grandparents, nephews, nieces and half-siblings. Although a history of schizophrenia in any of these second-degree relatives is not an absolute contraindication to using medicinal marijuana, it should be paid close attention. There is a believed association between eliciting a schizophrenic break in individuals who could be “on the edge” of developing the disease should they use, particularly smoke, THC-rich cannabis. Anyone with a more tertiary family history of schizophrenia should be made aware of this fact in case they observe in their family members (or themselves) anything remotely along the lines of psychotic behavior. Although this still remains a highly unlikely, almost reportable occurrence, it is good to be made aware of the possibility.

Generally speaking, there are not many absolute contraindications to using medicinal marijuana. A topic of further discussion is cardiac concerns, of which many guides referencing medicinal marijuana will explicitly recommend against cannabis usage (particularly smoking THC-rich cannabis) in patients with active, unstable heart disease. Patients with severe coronary artery disease (CAD) with any recent history of a heart attack (also known as “myocardial infarction” (MI)) are at special risk. Patients who have had coronary artery bypass graft (CABG) surgery are often placed in a special concern bracket and restricted cannabis for medicinal purposes, as are those who have had a significant number of percutaneous stents placed in their coronary arteries. Understandably, regardless of having these risk factors or not, any patient experiencing chest pain after using medicinal marijuana is asked to cease consumption immediately. This also remains an incredibly rare occurrence and is essentially only reported in individuals smoking THC-rich cannabis. Regardless, if this does occur and chest pain persists, emergency services should be promptly notified.

One final note to make clear with the IndicaMD program is the near sacred commitment IndicaMD employees have to preserving patient confidentiality. Our database is fully HIPAA-compliant and your information will be kept private. In our short time since formulating the service, we have already seen a couple of patients who are well-known in their fields and recognizable by many on a national level. We already include in our patient panel athletes, musicians and actors who many would never guess are medicinal marijuana patients. Rest assured, your privacy will be kept. IndicaMD employees are well aware of the extremely strict guidelines we have set preserving patient confidentiality and the very harsh repercussions for anyone violating the company code. The only people who will have any idea as to your patient status will be the IndicaMD physician you see online (1), the staff member helping to arrange logistics and mail your recommendation/certification if approved (2) and myself if the IndicaMD partnered physician in question requests secondary confirmation to see if a patient merits approval and for what duration (3). There do exist occasions when relative contraindications to medicinal marijuana warrant our request for patients to follow-up with us on a sooner basis often with arranged appointments with trusted specialist physicians in the interim. This can be done with or without a conditional medicinal marijuana approval in hand.

In summary, IndicaMD is a medicinal marijuana physician-run company that is very much by the people, for the people. If there are any questions, comments or concerns please do not hesitate to call us at the number listed on the front page of the website (844-307-9950) or email us at your leisure (hello@indicamd.com). We are here first and foremost for you!

DE O’Connell, MD

President & CEO
Paladin MD Services

References

  1. Fuller, T. (2017, July 13). Nevada Rushes to Address Shortage of Newly Legalized Marijuana. Retrieved July 25, 2017, from https://www.nytimes.com/2017/07/13/us/nevada-legal-marijuana-shortage.html
  2. Staggs, B. (2017, May 07). UC Irvine developing an interdisciplinary cannabis research institute. Retrieved July 25, 2017, from http://www.ocregister.com/2017/05/05/uc-irvine-developing-an-interdisciplinary-cannabis-research-institute/
  3. News Releases. (n.d.). Retrieved July 25, 2017, from https://www.uclahealth.org/april-20-inaugural-ucla-cannibis-research-symposium
By | 2017-07-25T12:08:56+00:00 July 25th, 2017|Medical|0 Comments

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